Labor costs and economic impact of a primary care clinical pharmacy service on postfracture care in postmenopausal women

Abstract

Study objective: To compare costs associated with two osteoporosis management interventions and to quantify cost avoidance due to projected hip fracture prevention.

Design: Labor and cost analysis within a retrospective cohort study.

Setting: Integrated health care delivery system.

Patients or participants: Women aged 67 or older with a documented fracture between January 1 and December 31, 2007, managed by either a Clinical Pharmacy Osteoporosis Management Service (CPOMS) or comparator service using a registered nurse (RN). Recommendations included dual-energy x-ray absorptiometry (DEXA) scans and/or bisphosphonate therapy as appropriate.

Measurement and main results: The primary end points were cost per patient reviewed, cost per patient achieving the quality end point of completing a DEXA scan or purchasing an antiosteoporosis medication, and cost avoidance due to projected hip fracture prevention. A total of 1129 women were managed by either CPOMS (n=827) or the comparator service (n=302). The cost of provider time for CPOMS and comparator group interventions was $25 ($21-$30) and $34 ($21-$53) per patient reviewed, respectively. The cost per patient achieving the quality end point was $92 ($77-$112) and $198 ($124-$307), respectively. If women in the CPOMS group persisted in receiving their bisphosphonate for 1 year, approximately two additional hip fractures would be avoided per 1000 patients reviewed. Based on this model, the projected annual cost of osteoporosis care for 1000 women was $619,736 (CPOMS) versus $726,887 (comparator service).

Conclusions: The CPOMS resulted in comparable cost per patient reviewed but a lower cost per patient achieving quality end points. When including costs associated with projected hip fractures, CPOMS was less expensive than the comparator group because more patients initiated drug therapy, which resulted in fewer projected hip fractures. From the health care payer's perspective, the CPOMS intervention is associated with a lower cost per patient achieving treatment recommendations while providing future cost savings because of fewer hip fractures.

Keywords: bisphosphonate; bone density; delivery of health care; economics; fractures; osteoporosis; pharmacists.