- Title
- An optimal and cost-effective approach to managing osteoporosis and preventing fractures in Singapore
- Creator
- Lau, Tang Ching
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2020
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- We then undertook a study to examine the incidence of hip fracture In Singapore from 2000 to 2017. We observed several important trends in the occurrence of hip fractures in this study. During the period 2000-2017, absolute numbers of hip fractures continued to increase, with a mean annual increase of 71 fractures per 100,000 and an Average Annual Percentage Change (AAPC) of 3.5% (95% CI: 3.3, 3.8). Nevertheless, the crude fracture rate per 100,000 declined in both men and women, indicating that the increase in absolute number of hip fractures was due to an increase in the numbers of women and men at risk for hip fracture. When crude rates per 100,000 were age-adjusted, fractures trends declined even more steeply, indicating the major contribution of the aging Singapore population to the increase in total number of fractures. With the available information on patients’ knowledge, attitude and practice, as well as the cost burden of fracture management in Singapore obtained from the studies as conducted in the thesis, we therefore undertook a fracture liaison service program (OPTIMAL) to prevent recurrent fractures from 2008 to 2016. The OPTIMAL program is a clinician champion-driven, case coordinator-run secondary prevention program for osteoporotic fractures. The program strives to narrow the prevalent care gap in osteoporosis care through a judicious combination of fracture case finding, appropriate assessment and evaluation, patient education on osteoporosis and risk factor management, education on nutrition, fall prevention and exercises for muscle strengthening, balance and coordination, in addition to the use of effective anti-osteoporosis pharmacological agents. The most important finding of this study was the reduction in all sites fracture risk by 41% and hip fracture risk by 47.1% of patients enrolled into the OPTIMAL program when compared with non-enrolees after two years. The absolute risk reduction in hip fracture rate was 7.67% (15.58% in non-enrolees versus 7.93% in OPTIMAL enrolled patients). The absolute reduction in fracture risk was 9% at 5 years. The OPTIMAL program prevented 77 hip fractures for every 1000 participants and reduce mortality by 40% over five years. This led to significant gains of 228 QALYs per 1000 patients. Patients in the program incurred higher costs due to costs of the intervention, BMD test, and osteoporosis treatment, but preventing subsequent hip fractures also saved costs. Discounting costs and benefits at 5 % per year, the program cost $5,607 more and gained 0.228 QALYs per patient, with an incremental cost-effectiveness ratio (ICER) of $24,636 per QALY gained. These results compared favourably with other observational studies and randomised controlled trials of similar fracture liaison service program (8). Taking together with the reduction in fracture, this projected good return of investment would support the cost-effectiveness of implementing such program in Singapore. Therefore, the overall results from the studies as presented in the thesis would indicate that with the aging population, there is a likelihood of increased osteoporosis-related fractures. This projected increase is expected to impose heavy financial burden to the health care system in Singapore. However, with a coordinated approach in managing osteoporosis as shown by the OPTIMAL program implemented in Singapore, it may be possible at least to damper the clinical and financial impact of osteoporosis-related fractures. The results from the studies in this thesis would also provide an example of tackling the problem of increased osteoporosis-related fractures faced by other countries, particularly in the Asia-Pacific region.
- Subject
- osteoporosis; fracture liaison service; cost utility analysis; Singapore; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1421748
- Identifier
- uon:37761
- Rights
- Copyright 2020 Tang Ching Lau
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 3 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 2 MB | Adobe Acrobat PDF | View Details Download |