title: The burden of osteoporotic hip fractures in Portugal: costs, health related quality of life and mortality.
abstract: The study rationale was to provide a detailed overview of the costs, quality of life and mortality of hip fractures in Portugal. Mean individual fracture-related costs were estimated at €13,434 [12,290; 14,576] for the first year and €5985 [4982; 7045] for the second year following the fracture.
  
  
  BACKGROUND
  Osteoporotic fractures represent a remarkable burden to health care systems and societies worldwide, which will tend to increase as life expectancy expands and lifestyle changes favour osteoporosis. The cost-effectiveness evaluation of intervention strategies demands accurate data on the epidemiological and economical reality to be addressed.
  
  
  METHODS
  Information was collected retrospectively on consumption of resources and changes in quality of life attributable to fracture as well as mortality, regarding 186 patients randomly selected to represent the distribution of hip fractures in the Portuguese population, in terms of gender, age and geographical provenience. Data were cross-tabulated with socio-demographic variables and individual resource consumption to estimate the burden of disease. A societal perspective was adopted, including direct and indirect costs. Multivariate analyses were carried out to assess the main determinants of health-related quality of life (HrQoL).
  
  
  RESULTS
  Mean individual fracture-related costs were estimated at €13,434 [12,290; 14,576] for the first year and €5985 [4982; 7045] for the second year following the fracture. In 2011 the economic burden attributable to osteoporotic hip fractures in Portugal could be estimated at €216 million. Mean reduction in HrQoL 12 months after fracture was estimated at 0.34. Regression analysis showed that age was associated with a higher loss of HrQoL, whereas education had the opposing effect. We observed 12 % excess mortality in the first year after hip fracture, when compared to the gender and age-matched general population.
  
  
  CONCLUSIONS
  Results of this study indicate that osteoporotic hip fractures are, also in Portugal, despite its low incidence of fractures and cost per event, associated with a high societal burden, in terms of costs, loss in HrQoL and mortality. These data provide valuable input to the design and selection of fracture prevention strategies.
authors.affiliation: Rheumatology Department, Centro Hospitalar Universitário de Coimbra, 3000-075, Coimbra, Portugal. amarques@reumahuc.org.
authors.forename: A
authors.initials: A
authors.lastname: Marques
authors.affiliation: Centro de Estudos e Investigação em Saúde da Universidade de Coimbra, Faculty of Economics, University of Coimbra, Av. Dias da Silva, 1653004-512, Coimbra, Portugal.
authors.forename: Ó
authors.initials: Ó
authors.lastname: Lourenço
authors.affiliation: Rheumatology Department, Centro Hospitalar Universitário de Coimbra, 3000-075, Coimbra, Portugal.|Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
authors.forename: J A P
authors.initials: JA
authors.lastname: da Silva
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017281:Cost of Illness; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006295:Health Resources / Q000706:statistics & numerical data; D006620:Hip Fractures / Q000191:economics* / Q000401:mortality / Q000534:rehabilitation; D006801:Humans; D008297:Male; D058866:Osteoporotic Fractures / Q000191:economics* / Q000401:mortality / Q000534:rehabilitation; D011174:Portugal / Q000453:epidemiology; D011594:Psychometrics; D011788:Quality of Life; D012189:Retrospective Studies
keywords: Costs; Fracture; Mortality; Osteoporosis; Quality of life