Introduction
Methods
Overview
Data sources
Identification of fractures and attribution to osteoporosis
Estimation of the costs associated with hospitalizations, emergency room visits, and same day surgeries
Cost component | Item | Unit costs (data source) | Main costing assumptions |
---|---|---|---|
Acute care (includes acute care bed admissions, emergency room visits, day surgeries—with identical methodology) | Cost per RIW | $5,399.04 (CIHI) | • Quebec hospitalizations extrapolated from all other Canadian provinces |
Physician visit feesa
| $79.20 (admission); $55.45 (2nd, 3rd, and last day); $29.20 (other days) (OSBPS) | • Ontario data on number of same day surgeries and emergency room visits extrapolated to Canada | |
Diagnostic tests | Range from $33 for wrist X-ray to $117 for MRI of vertebral fracture (average of $75) (OSBPS) | • Patient-level costing | |
Surgeon, surgical assistant, and anesthesiologist procedure fees for assessment, procedure, and follow-up | Range from $76 immobilization of hip to $2,551 for fixation or reduction for vertebral fracture (average $1,352) (OSBPS) | ||
Rehabilitation | Cost per RIW per stay | $15,449 (CIHI) | • Based on net transfers from acute care |
• Length of stay and costing based on rehabilitation database | |||
• Patient-level costing | |||
Continuing care | Cost per RIW per day | $420.12 (CIHI) | • Based on net transfers from acute care |
• Length of stay and costing based on continuing database | |||
• Patient-level costing | |||
Home care | Cost per week | $168.50 (MDS Inter-rai) | • Ontario data on number of recipients extrapolated to Canada |
• Length of stay based on Manitoba data and unit costs from Ontario | |||
Long-term care | Cost per day | $147.77 (Ontario provincial budget) | • Based on net transfers from acute care |
• Length of stay based on Manitoba data and unit costs from Ontario | |||
Outpatient physician services | Physician visit fees | General practice: consultation (1 per year) $56.10, repeat consultation $42.35 | Assume 50% of visits are consultation and 50% are repeat consultations |
Internal medicine: consultation $132.50, repeat consultation $82.90 | |||
Drug costs | National estimates from public and private plans | Retail drug price as charged, plus $7.00 dispensing fee (IMS Brogan PharmaStat©) | 100% of public data programs covered in most provinces (except PEI and Social Services in Alberta) |
Over 65% of all national privately reimbursed prescriptions | |||
Productivity losses | Cost per day | $24.12 per hour × 8 h per day (Statistics Canada) | • Number of days based on CAMOS data |
Estimation of the costs associated with rehabilitation, continuing care, long-term care, and home care
Estimation of physician and prescription drug costs
Estimation of indirect costs
Sensitivity analyses
Results
Hospitalizations, same day surgeries, and emergency room visits due to osteoporosis-related fractures
Fracture type | Number of hospitalizations: all Canada except Quebec | Number of hospitalizations: Quebec (extrapolated) | Number of hospitalizations: Canada | Number of hospitalized days: Canada | ||||
---|---|---|---|---|---|---|---|---|
Women | Men | Total | Women | Men | Total | Total | Total | |
Hip | 15,519 | 6,165 | 21,684 | 5,156 | 2,027 | 7,183 | 28,867 | 448,776 |
Humerus | 1,623 | 4,54 | 2,077 | 397 | 111 | 508 | 2,585 | 30,141 |
Vertebral | 1,077 | 6,45 | 1,722 | 360 | 215 | 575 | 2,297 | 34,490 |
Wrist | 2,983 | 9,37 | 3,920 | 714 | 224 | 938 | 4,858 | 24,132 |
Multiple site | 3,325 | 1,579 | 4,904 | 762 | 362 | 1,124 | 6,028 | 124,000 |
Other site | 7,034 | 3,366 | 10,400 | 1,608 | 770 | 2,378 | 12,778 | 171,055 |
Total | 31,561 | 13,146 | 44,707 | 8,997 | 3,709 | 12,709 | 57,413 | 832,594 |
Costs associated with hospitalizations, same day surgeries, and emergency room visits
Fracture type | Emergency care | Acute care admissions | Same day surgery | Total acute care costs | Percent of total costs |
---|---|---|---|---|---|
Hip | $40,493,177 | $582,058,662 | $288,169 | $622,840,008 | 53% |
Humerus | $11,681,974 | $32,324,504 | $451,514 | $44,457,992 | 4% |
Vertebral | $5,186,182 | $31,720,622 | $237,393 | $37,144,197 | 3% |
Wrist | $55,420,934 | $43,028,096 | $9,497,406 | $107,946,436 | 9% |
Multiple sites | $9,322,424 | $141,035,749 | $321,292 | $150,679,465 | 13% |
Other sites | $38,803,610 | $178,163,216 | $1,239,783 | $218,206,609 | 18% |
Total | $160,908,302 | $1,008,330,849 | $12,035,556 | $1,181,274,707 | 100% |
Percent of total costs | 14% | 85% | 1% | 100% | |
Percent of total costs attributed to women | 72% | 71% | 76% | 71% |
Costs associated with rehabilitation, continuing care, long-term care, and home care
Physician and prescription drug costs
Indirect costs
Burden of osteoporosis: base case and sensitivity analyses
Cost component | Base case analysis | Change attribution rates of osteoporosis using ROCQ data instead of MacKey et al. | Add costs attributed to hospitalizations due to osteoporosis only (N = 2,096) | Assumes that a proportion of long-term care residents were admitted due to osteoporosis-related fractures | Assumes that all high and low-trauma fractures are osteoporotic |
---|---|---|---|---|---|
Acute care costs (hospitalization, same day surgeries, and emergency room visits) | $1,181,274,707 | $1,134,803,061 | $1,219,450,008 | Unchanged | $1,318,689,391 |
Rehabilitation costs | $97,169,606 | $95,280,270 | $103,457,541 | Unchanged | $120,170,851 |
Continuing care costs | $112,720,625 | $110,024,143 | $119,837,738 | Unchanged | $140,969,693 |
Long-term care | $28,275,046 | $26,487,393 | Unchanged | $1,641,017,974 | $46,532,134 |
Home care services | $244,565,735 | Unchanged | Unchanged | Unchanged | Unchanged |
Physician costs | $142,589,880 | Unchanged | Unchanged | Unchanged | Unchanged |
Prescribed drug costs | $390,854,843 | Unchanged | Unchanged | Unchanged | Unchanged |
Indirect costs | $115,311,966 | $115,045,033 | Unchanged | Unchanged | $117,076,070 |
Total cost | $2,312,762,408 | $2,263,759,530 | $2,364,342,757 | $3,925,505,337 | $2,519,684,494 |