Indirect costs account for half of the total costs of an osteoporotic fracture: a prospective evaluation.
Data on direct and indirect costs of clinical fractures in 116 osteoporotic patients 50 years and older were prospectively collected using cost diaries. Indirect costs accounted for roughly half of the total costs, with a contribution of at least 81% of these costs in employed patients.


BACKGROUND
The aim of this prospective study was to gain insight into the current total costs of clinical fractures in osteoporotic patients aged 50 years and older.


METHODS
In a study in the Netherlands, patients prospectively filled out cost diaries every 3 months, during 1 year after a clinical fracture. Primary analyses were performed on those patients with all four cost diaries returned. In-depth analyses of indirect costs were performed, dividing results for employed and unemployed patients. Sensitivity analyses using imputation techniques were performed on patients who returned two or three diaries


RESULTS
Of the 116 included patients, 69 completed all four diaries, 24 only two or three, and 23 patient completed one or no diaries. For all fractures, approximately 50% of the total costs were due to indirect costs; employed patients contributed for at least 81% of the indirect cost. Humerus fractures were most expensive with a total 1-year cost of €16.841 per patient. Indirect costs in the group with clinical spine fractures were highest (<euro>12.522), accounting for 89.1% of the total costs for this fracture.


CONCLUSIONS
Indirect costs account for roughly half of the total costs of clinical fractures, which are largely related to sick leave. When performing cost analyses in fracture patients, we advise a societal perspective in which indirect costs are also considered, and to apply a patient derived prospective data collection method to get a 'true' and complete image of the total costs due to clinical fractures.
Department of Rheumatology, VU Medical Center, Amsterdam, The Netherlands, d.eekman@vumc.nl.
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Eekman
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ter Wee
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Coupé
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Erisek-Demirtas
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Kramer
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Lems
D000368:Aged; D017281:Cost of Illness; D004651:Employment; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006295:Health Resources / Q000706:statistics & numerical data; D006302:Health Services Research / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010024:Osteoporosis / Q000191:economics / Q000628:therapy; D058866:Osteoporotic Fractures / Q000191:economics* / Q000628:therapy; D011446:Prospective Studies; D012680:Sensitivity and Specificity