title: Pathologic fracture and healthcare resource utilisation: A retrospective study in eight European countries.
abstract: BACKGROUND
  Skeletal-related events (SREs; pathologic fracture [PF], spinal cord compression and radiation or surgery to bone) are common complications of bone metastases or bone lesions and can impose a considerable burden on patients and healthcare systems. In this study, the healthcare resource utilisation (HRU) associated with PFs in patients with bone metastases or lesions secondary to solid tumours or multiple myeloma was estimated in eight European countries.
  
  
  METHODS
  Eligible patients were identified in Austria, the Czech Republic, Finland, Greece, Poland, Portugal, Sweden and Switzerland. HRU data were extracted from hospital charts from 3.5 months before the index PF (defined as a PF preceded by a 6.5-month period without a SRE) until 3 months after the last SRE during the study period. Changes from baseline in the number and duration of inpatient stays, number of outpatient visits and number of procedures provided were recorded.
  
  
  RESULTS
  Overall, 118 patients with PFs of long bones (those longer than they are wide, e.g. the femur) and 241 patients with PFs of other bones were included. Overall, HRU was greater in patients with long bone PFs than in those with PFs of other bones. A higher proportion of patients with long bone PFs had multiple SREs (79.7%), and more of their SREs were considered to be linked (73.4%) compared with patients with PFs of other bones (51.0% and 47.2%, respectively).
  
  
  CONCLUSIONS
  The increased number and duration of inpatient stays for PFs of long bones compared with those for PFs of other bones may be due in part to the requirement for complicated and lengthy rehabilitation in patients with long bone PFs. Implementing strategies to delay or reduce the number of PFs experienced by patients with bone metastases or lesions may therefore reduce the associated HRU and patient burden.
authors.affiliation: CHU Brugmann, Université Libre de Bruxelles, Place A.Van Gehuchten 4, 1020 Brussels, Belgium.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Body
authors.affiliation: Kantonsspital Graubünden, Loëstrasse 170, 7000 Chur, Switzerland.
authors.forename: Yves Pascal
authors.initials: YP
authors.lastname: Acklin
authors.affiliation: Centre for Observational Research, Amgen Ltd, 1 Uxbridge Business Park, Sanderson Road, Uxbridge UB8 1DH, UK.
authors.forename: Oliver
authors.initials: O
authors.lastname: Gunther
authors.affiliation: Global Health Economics, Amgen (Europe) GmbH, Dammstrasse 23, 6300 Zug, Switzerland.
authors.forename: Guy
authors.initials: G
authors.lastname: Hechmati
authors.affiliation: Universidade NOVA de Lisboa, National School of Public Health, Avenida Padre Cruz 1600-560, Lisbon, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Pereira
authors.affiliation: Department of Health Services Management, National School of Public Health, 196 Alexandras Avenue, Athens, Greece.
authors.forename: Nikos
authors.initials: N
authors.lastname: Maniadakis
authors.affiliation: University of Athens School of Medicine, Alexandra University Hospital, V. Sofias and Lourou 1, 11528 Athens, Greece.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Terpos
authors.affiliation: University Hospital, Alej Svobody 923/80, 323 00 Pilsen, Czech Republic.
authors.forename: Jindrich
authors.initials: J
authors.lastname: Finek
authors.affiliation: Kantonsspital Graubünden, Loëstrasse 170, 7000 Chur, Switzerland.
authors.forename: Roger
authors.initials: R
authors.lastname: von Moos
authors.affiliation: Centre for Observational Research, Amgen Ltd, 1 Uxbridge Business Park, Sanderson Road, Uxbridge UB8 1DH, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Talbot
authors.affiliation: HAGA Hospital, Sportlaan 600, 2566 The Hague, The Netherlands.
authors.forename: Harm
authors.initials: H
authors.lastname: Sleeboom
keywords: Bone metastases; HRU, healthcare resource utilisation; Healthcare resource utilisation; ICD, International Classification of Diseases; PF, pathologic fracture; Pathologic fracture; SD, standard deviation; SRE, skeletal-related event; Skeletal-related event; Solid tumour