A multi-study cost-effectiveness comparison of the QFracture and FRAX fracture risk algorithms

BACKGROUND: The FRAX and QFracture risk calculators have previously been validated but their relative performance with respect to cost-effectiveness has yet to be evaluated. METHODS: The relative costs of implementing these two fracture risk calculators were assessed in two scenarios, firstly in a case-control group of 584 post-menopausal women using the National Osteoporosis Guideline Group (NOGG) guidelines, and then using the QResearch database, which contains over 8 million patient-years of prospective data. RESULTS: QFracture was more cost-effective in the first scenario while the underlying cost drivers were different for each algorithm; however, the cost per fracture prevented could not be estimated. The incremental cost-effectiveness ratio of FRAX was £516.22 per hip fracture saved compared with QFracture in the second scenario. LIMITATIONS: The comparison yielded virtually identical false negative rates for both calculators. In cases where these rates are significantly different, an all-encompassing cost comparison would be a challenge. CONCLUSIONS: FRAX was more cost-effective per fracture prevented when the same risk assessment cost was used for the two algorithms; a key factor in assessing the relative cost-effectiveness of these algorithms is the cost of the risk assessment process. QFracture considers more risk factors than FRAX and has been developed to incorporate additional risk factors in the future. This makes QFracture costly, however, this calculator may benefit from automated systems to reduce its cost of implementation.