Cost Effectiveness

The cost of the old versus new system were calculated based on the cost of consultant led and nurse led clinic attendances at our institution. Data was obtained from the NHS Scotland Costs Book for 2011-12. We received guidance from the Health Board finance department. The total direct cost of a consultant led out-patient appointment was £91.77. This was comprised of a consultant staffing cost of £53.66. The non-consultant clinic costs were therefore £38.11 (nursing and associated other costs such as pharmacy and radiology). The consultant input to the virtual clinic varied from one to two hours per session. A standard consultant session comprises four hours. The consultant input per patient in the VFC therefore varied from £13.41 to £26.83 per VFC patient. The total cost per VFC patient was therefore £51.52 to £64.94. We have included calculations for the range of potential direct cost savings based on the consultant input.

The total direct costs associated with all these patients requiring consultant review was £585,951. Under the redesigned system, the virtual fracture clinic reviews and telephone calls were delivered by nurses, with consultant decision making input for one to two hours per clinic. The overall cost of the redesigned system varied from £429,780 to £487,082 depending on consultant input. This therefore resulted in a cost saving of £98,868 to £156,171 for the study period.

Number (n)

Unit Cost (£)

Total Cost (£)

Potential Cost under traditional system of universal consultant review




Redesigned Fracture Clinic Process

Cons Time (1hr)

VFC (1 hr consultant input)



Consulant OPD




Nurse-led clinic






Potential Saving