Direct and indirect costs of non-vertebral fracture patients with osteoporosis in the US.
Osteoporosis is a condition marked by low bone mineral density and the deterioration of bone tissue. One of the main clinical and economic consequences of osteoporosis is skeletal fractures. To assess the healthcare and work loss costs of US patients with non-vertebral (NV) osteoporotic fractures. Privately insured (aged 18-64 years) and Medicare (aged >/=65 years) patients with osteoporosis (ICD-9-CM code: 733.0x) were identified during 1999-2006 using two claims databases. Patients with an NV fracture (femur, pelvis, lower leg, upper arm, forearm, rib or hip) were matched randomly on age, sex, employment status and geographic region to controls with osteoporosis and no fractures. Patient characteristics and annual healthcare costs were assessed over the year following the index fracture for privately insured (n = 4764) and Medicare (n = 48 742) beneficiaries (Medicare drug costs were estimated using multivariable models). Indirect (i.e. work loss) costs were calculated for a subset of privately insured, employed patients with available disability data (n = 1148). All costs were reported in $US, year 2006 values. In Medicare, mean incremental healthcare costs per NV fracture patient were $US13 387 ($US22 466 vs $US9079; p < 0.05). The most expensive patients had index fractures of the hip, multiple sites and femur (incremental costs of $US25 519, $US20 137 and $US19 403, respectively). Patients with NV non-hip (NVNH) fractures had incremental healthcare costs of $US7868 per patient ($US16 704 vs $US8836; p < 0.05). Aggregate annual incremental healthcare costs of NVNH patients in the Medicare research sample (n = 35 933) were $US282.7 million compared with $US204.1 million for hip fracture patients (n = 7997). Among the privately insured, mean incremental healthcare costs per NV fracture patient were $US5961 ($US11 636 vs $US5675; p < 0.05). The most expensive patients had index fractures of the hip, multiple sites and pelvis (incremental costs of $US13 801, $US9642 and $US8164, respectively). Annual incremental healthcare costs per NVNH patient were $US5381 ($US11 090 vs $US5709; p < 0.05). Aggregate annual incremental healthcare costs of NVNH patients in the privately insured sample (n = 4478) were $US24.1 million compared with $US3.5 million for hip fracture patients (n = 255). Mean incremental work loss costs per NV fracture employee were $US1956 ($US4349 vs $US2393; p < 0.05). Among patients with available disability data, work loss accounted for 29.5% of total costs per NV fracture employee. The cost burden of NV fracture patients to payers is substantial. Although hip fracture patients were more costly per patient in both Medicare and privately insured samples, NVNH fracture patients still had substantial incremental costs. Because NVNH patients accounted for a larger proportion of the fracture population, they were associated with greater aggregate incremental healthcare costs than hip fracture patients.
Pike
Crystal
C
Analysis Group, Inc., Boston, Massachusetts, USA.
Birnbaum
Howard G
HG
Schiller
Matt
M
Sharma
Hari
H
Burge
Russel
R
Edgell
Eric T
ET
D000041:Absenteeism; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D015897:Comorbidity; D017281:Cost of Illness; D016527:Drug Costs / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis / Q000191:economics* / Q000209:etiology* / Q000628:therapy; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007342:Insurance Benefits / Q000706:statistics & numerical data; D018868:Insurance, Disability; D007348:Insurance, Health / Q000706:statistics & numerical data; D008134:Long-Term Care / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications* / Q000191:economics / Q000628:therapy; D012737:Sex Factors; D018582:Sick Leave / Q000706:statistics & numerical data; D014481:United States
Osteoporos Int. 2009 Apr;20(4):527-36
18766294
Bone. 2002 Apr;30(4):631-6
11934657
Osteoporos Int. 2005 Jan;16(1):78-85
15167988
J Chronic Dis. 1987;40(5):373-83
3558716
Osteoporos Int. 2003 Jun;14(5):383-8
12730750
Rheumatol Int. 2006 Oct;26(12):1063-72
16953395
Osteoporos Int. 2006 Feb;17(2):252-8
16193229
Dis Manag. 2003 Summer;6(2):83-91
14577902
J Bone Miner Res. 2003 Jun;18(6):1139-41
12817771
Pharmacoeconomics. 2006;24(9):869-90
16942122
Bone. 1994 Jul-Aug;15(4):377-86
7917575
Womens Health Issues. 2005 May-Jun;15(3):97-108
15894195
Osteoporos Int. 2005 Apr;16(4):359-71
15340799
Curr Med Res Opin. 2008 Jun;24(6):1781-8
18489813
Foot Ankle Int. 1998 Apr;19(4):221-4
9578100
Osteoporos Int. 2005 Dec;16(12):2046-52
16228106
Value Health. 2007 Mar-Apr;10(2):144-52
17391423
Methods Mol Biol. 2008;455:125-34
18463815
JAMA. 2001 Dec 12;286(22):2815-22
11735756
Osteoporos Int. 2001 Dec;12(12):1042-9
11846331
J Bone Miner Res. 1997 Jan;12(1):24-35
9240722
Gerontology. 2001 Jan-Feb;47(1):21-9
11244288
J Clin Epidemiol. 1993 Oct;46(10):1075-9; discussion 1081-90
8410092
Clin Orthop Relat Res. 1980 Jul-Aug;(150):172-6
7428216
Clin Geriatr Med. 2002 Aug;18(3):529-55
12424871
Osteoporos Int. 2005 Dec;16(12):1545-57
15942702
J Bone Joint Surg Am. 2003 May;85(5):820-4
12728031
Curr Med Res Opin. 2008 Mar;24(3):695-705
18226324
J Bone Miner Res. 2007 Mar;22(3):465-75
17144789