title: Direct healthcare costs of osteoporosis-related fractures in managed care patients receiving pharmacological osteoporosis therapy.
abstract: BACKGROUND
  Osteoporosis is a common condition and the economic burden of osteoporosis-related fractures is significant. While studies have reported the incremental or attributable costs of osteoporosis-related fracture, data on the economic impact of osteoporosis-related fractures in commercial health plan populations are limited.
  
  
  OBJECTIVE
  To estimate the direct costs of osteoporosis-related fractures among pharmacologically treated patients in a large, commercially insured population between 2005 and 2008.
  
  
  METHODS
  In this retrospective cohort study, patients were identified from a large, commercially insured population with integrated pharmacy and medical claims. Inclusion criteria were age 45-64 years; one or more osteoporosis medication claim(s) with first (index) claim between 1 January 2005 and 30 April 2008; and continuous insurance coverage for ≥12 months pre-index and ≥6 months post-index. Patients with pre-index Paget's disease or malignant neoplasm; skilled nursing facility stay; combination therapy at index; or fracture ≤6 months post-index were excluded. A generalized linear model compared differences in 6-month pre-/post-event costs for patients with and without fracture. Propensity score weighting was used to ensure comparability of fracture and non-fracture patients. Generalized estimating equations accounted for repeated measures.
  
  
  RESULTS
  The study included 49,680 patients (2613 with fracture) with a mean (SD) age of 56.4 (4.7) years; 95.9% were female. Mean differences between pre- and post-event direct costs were $US14,049 (95% CI 7670, 20,428) for patients with vertebral fractures, $US16,663 (95% CI 11,690, 21,636) for patients with hip fractures, and $US7582 (95% CI 6532, 8632) for patients with other fractures. After adjusting for covariates, osteoporosis-related fractures were associated with an additional $US9996 (95% CI 8838, 11,154; p < 0.0001) in direct costs per patient across all fracture types during the 6 months following fracture.
  
  
  CONCLUSIONS
  Patients with osteoporosis-related fractures were found to incur nearly $US10,000 in estimated additional direct healthcare costs in the 6 months post-fracture, compared with patients with no fracture. Reduced fracture risk may lower associated direct healthcare costs.
authors.affiliation: Amgen Inc., Thousand Oaks, CA, USA. hemav@amgen.com
authors.forename: Hema N
authors.initials: HN
authors.lastname: Viswanathan
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Curtis
authors.forename: Jingbo
authors.initials: J
authors.lastname: Yu
authors.forename: Jeffrey
authors.initials: J
authors.lastname: White
authors.forename: Bradley S
authors.initials: BS
authors.lastname: Stolshek
authors.forename: Claire
authors.initials: C
authors.lastname: Merinar
authors.forename: Akhila
authors.initials: A
authors.lastname: Balasubramanian
authors.forename: Joel D
authors.initials: JD
authors.lastname: Kallich
authors.forename: John L
authors.initials: JL
authors.lastname: Adams
authors.forename: Sally W
authors.initials: SW
authors.lastname: Wade
mesh_terms: D050071:Bone Density Conservation Agents / Q000191:economics* / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D005260:Female; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008329:Managed Care Programs / Q000191:economics*; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy / Q000191:economics*; D058866:Osteoporotic Fractures / Q000191:economics*; D012189:Retrospective Studies; D014481:United States
chemical_list: D050071:Bone Density Conservation Agents