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The burden of osteoporotic hip fractures in Portugal: costs, health related quality of life and mortality

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Abstract

Summary

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.

Introduction

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.

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Notes

  1. €2500 corresponds to the comprehensive cost of inpatient care to treat a hip fracture. Table 1 shows the source of this figure.

  2. €20,000 corresponds approximately to the upper 95 % confidence interval for Sweden [7], assuming the replacement costing method.

  3. [13] refers that and estimate of the SD can be found by computing the range divided by 4.

  4. € 800 is approximately equivalent to 5 % of the mean cost of hip fracture in Sweden [7] assuming the replacement cost method

  5. The sample size estimation accounted for fact that we are extracting a random sample from a finite population.

References

  1. Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J et al (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 8(1-2):136

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Johnell O (1997) The socioeconomic burden of fractures: today and in the 21st century. Am J Med 103(2a):20S–25S, discussion 5S-6S

    Article  CAS  PubMed  Google Scholar 

  3. Harvey N, Dennison E, Cooper C (2010) Osteoporosis: impact on health and economics. Nat Rev Rheumatol 6(2):99–105

    Article  PubMed  Google Scholar 

  4. Marques A, Mota A, Canhao H, Romeu JC, Machado P, Ruano A et al (2013) A FRAX model for the estimation of osteoporotic fracture probability in Portugal. Acta Reumatol Port 38(2):104–112

    PubMed  Google Scholar 

  5. Kanis JA, Oden A, McCloskey EV, Johansson H, Wahl DA, Cooper C (2012) A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int: J Established Result Cooperation Eur Found Osteoporos Nat Osteoporos Found USA 23(9):2239–2256

    Article  CAS  Google Scholar 

  6. Tarricone R (2006) Cost-of-illness analysis. What room in health economics? Health Policy (Amsterdam, Netherlands) 77(1):51–63

    Article  Google Scholar 

  7. Strom O, Borgstrom F, Zethraeus N, Johnell O, Lidgren L, Ponzer S et al (2008) Long-term cost and effect on quality of life of osteoporosis-related fractures in Sweden. Acta Orthop 79(2):269–280

    Article  PubMed  Google Scholar 

  8. Budhia S, Mikyas Y, Tang M, Badamgarav E (2012) Osteoporotic fractures: a systematic review of U.S. healthcare costs and resource utilization. PharmacoEconomics 30(2):147–170

    Article  PubMed  Google Scholar 

  9. Ferreira LN, Ferreira PL, Pereira LN, Oppe M (2013) EQ-5D Portuguese population norms. Quality of Life Research: an international journal of quality of life aspects of treatment, care and rehabilitation

  10. Qu B, Ma Y, Yan M, Wu HH, Fan L, Liao DF et al (2014) The economic burden of fracture patients with osteoporosis in western China. Osteoporos Int: J Established Result Cooperation Eur Found Osteoporos Nat Osteoporos Found USA 25(7):1853–1860

    Article  CAS  Google Scholar 

  11. Borgstrom F, Zethraeus N, Johnell O, Lidgren L, Ponzer S, Svensson O et al (2006) Costs and quality of life associated with osteoporosis-related fractures in Sweden. Osteoporos Int: J Established Result Cooperation Eur Found Osteoporos Nat Osteoporos Found USA 17(5):637–650

    Article  Google Scholar 

  12. Drummond MF (1988) Methods for the economic evaluation of health care programmes: Oxford University

  13. Cochran WG (1977) Sampling techniques. New York, Wiley. 98:259–61

  14. Scheaffer R, Mendenhall III W, Ott R, Gerow K (2011) Elementary survey sampling: Cengage Learning

  15. Cleves M (2008) An introduction to survival analysis using Stata: Stata Press

  16. Osnes EK, Lofthus CM, Meyer HE, Falch JA, Nordsletten L, Cappelen I et al (2004) Consequences of hip fracture on activities of daily life and residential needs. Osteoporos Int: J Established Result Cooperation Eur Found Osteoporos Nat Osteoporos Found USA 15(7):567–574

    CAS  Google Scholar 

  17. Bonafede M, Espindle D, Bower AG (2013) The direct and indirect costs of long bone fractures in a working age US population. J Med Econ 16(1):169–178

    Article  PubMed  Google Scholar 

  18. Zielinski SM, Bouwmans CA, Heetveld MJ, Bhandari M, Patka P, Van Lieshout EM (2014) The societal costs of femoral neck fracture patients treated with internal fixation. Osteoporos Int: J Established Result Cooperation Eur Found Osteoporos Nat Osteoporos Found USA 25(3):875–885

    Article  CAS  Google Scholar 

  19. Lambrelli D, Burge R, Raluy-Callado M, Chen SY, Wu N, Schoenfeld MJ (2014) Retrospective database study to assess the economic impact of hip fracture in the United Kingdom. Journal of Medical Economics. 1–9

  20. Nikitovic M, Wodchis WP, Krahn MD, Cadarette SM (2013) Direct health-care costs attributed to hip fractures among seniors: a matched cohort study. Osteoporos Int: J Established Result Cooperation Eur Found Osteoporos Nat Osteoporos Found USA 24(2):659–669

    Article  CAS  Google Scholar 

  21. Sahota O, Morgan N, Moran CG (2012) The direct cost of acute hip fracture care in care home residents in the UK. Osteoporos Int: J Established Result Cooperation Eur Found Osteoporos Nat Osteoporos Found USA 23(3):917–920

    Article  CAS  Google Scholar 

  22. Borgstrom F, Lekander I, Ivergard M, Strom O, Svedbom A, Alekna V et al (2013) The International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS)–quality of life during the first 4 months after fracture. Osteoporos Int: J Established Result Cooperation Eur Found Osteoporos Nat Osteoporos Found USA 24(3):811–823

    Article  CAS  Google Scholar 

  23. Peasgood T, Herrmann K, Kanis JA, Brazier JE (2009) An updated systematic review of health state utility values for osteoporosis related conditions. Osteoporos Int: J Established Result Cooperation Eur Found Osteoporos Nat Osteoporos Found USA 20(6):853–868

    Article  CAS  Google Scholar 

  24. Hagino H, Nakamura T, Fujiwara S, Oeki M, Okano T, Teshima R (2009) Sequential change in quality of life for patients with incident clinical fractures: a prospective study. Osteoporos Int: J Established Result Cooperation Eur Found Osteoporos Nat Osteoporos Found USA 20(5):695–702

    Article  CAS  Google Scholar 

  25. Silverman SL (2009) From randomized controlled trials to observational studies. Am J Med 122(2):114–120

    Article  PubMed  Google Scholar 

  26. Vandenbroucke JP, von Elm E, Altman DG, Gotzsche PC, Mulrow CD, Pocock SJ et al (2007) Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Ann Intern Med 147(8):W163–W194

    Article  PubMed  Google Scholar 

  27. Vassar M, Holzmann M (2013) The retrospective chart review: important methodological considerations. J Educ Eval Health Prof 10:12

    Article  PubMed  Google Scholar 

  28. Parsons N, Griffin XL, Achten J, Costa ML (2014) Outcome assessment after hip fracture: is EQ-5D the answer? Bone Joint Res 3(3):69–75

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  29. van Agt HM, Essink-Bot ML, Krabbe PF, Bonsel GJ (1994) Test-retest reliability of health state valuations collected with the EuroQol questionnaire. Soc Sci Med (1982) 39(11):1537–1544

    Article  Google Scholar 

  30. Alolabi B, Bajammal S, Shirali J, Karanicolas PJ, Gafni A, Bhandari M (2009) Treatment of displaced femoral neck fractures in the elderly: a cost-benefit analysis. J Orthop Trauma 23(6):442–446

    Article  PubMed  Google Scholar 

  31. Boonen S, Singer AJ (2008) Osteoporosis management: impact of fracture type on cost and quality of life in patients at risk for fracture I. Curr Med Res Opin 24(6):1781–1788

    Article  PubMed  Google Scholar 

  32. Leslie WD, Lix LM, Finlayson GS, Metge CJ, Morin SN, Majumdar SR (2013) Direct healthcare costs for 5 years post-fracture in Canada: a long-term population-based assessment. Osteoporos Int: J Established Result Cooperation Eur Found Osteoporos Nat Osteoporos Found USA 24(5):1697–1705

    Article  CAS  Google Scholar 

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Acknowledgments

The authors acknowledge the elements of the Portuguese working group for the study of the burden of hip fractures in Portugal: Patrícia Pinto, Graça Sequeira, Pedro Abreu, Ana Façanha, Benjamin Rodrigues, Nuno Geada, Bruno Canilho, Rogério Barroso, José Franco, Henrique de Jesus, Gabriel Xavier, Sandra Sousa, Viviana Tavares, Pedro Cantista, Tiago Meirinhos, Luís Palma, Sandra Martins, Hugo Aleixo, Leite da Cunha, Ana Raposo, Marcos Cerqueira, Helena Canhão, Gonçalo Martinho, Francisco Mendes, Cláudia Quinta, José Mousinho, Maria Carmo Barbosa, Mafalda Batista, Lúcia Costa, Ana Roxo, Ana Abrantes, Manuel Sousa, Cláudia Vaz and Paulo Felicíssimo, for the identification, selection, randomization and informed consent collection of the patients included in this study. This study is supported by unrestricted grants from the Direção Geral da Saúde and Amgen, which had no role in the design of the study or the writing or review of the paper.

Conflicts of interest

None.

Funding

This study was supported by unrestricted grants from the Direção Geral da Saúde and Amgen which had no role in the design of the study, the writing or review of the paper.

Author information

Authors and Affiliations

  1. Rheumatology Department, Centro Hospitalar Universitário de Coimbra, 3000-075, Coimbra, Portugal

    A. Marques & J. A. P. da Silva

  2. 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

    Ó. Lourenço

  3. Faculty of Medicine, University of Coimbra, Coimbra, Portugal

    J. A. P. da Silva

Authors
  1. A. Marques
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  2. Ó. Lourenço
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  3. J. A. P. da Silva
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on Behalf of the Portuguese Working Group for the Study of the Burden of Hip Fractures in Portugal

Corresponding author

Correspondence to A. Marques.

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Marques, A., Lourenço, Ó., da Silva, J.A.P. et al. The burden of osteoporotic hip fractures in Portugal: costs, health related quality of life and mortality. Osteoporos Int 26, 2623–2630 (2015). https://doi.org/10.1007/s00198-015-3171-5

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