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The health burden and costs of incident fractures attributable to osteoporosis from 2010 to 2050 in Germany—a demographic simulation model

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Abstract

Summary

To predict the burden of incident osteoporosis attributable fractures (OAF) in Germany, an economic simulation model was built. The burden of OAF will sharply increase until 2050. Future demand for hospital and long-term care can be expected to substantially rise and should be considered in future healthcare planning.

Introduction

The aim of this study was to develop an innovative simulation model to predict the burden of incident OAF occurring in the German population, aged >50, in the time period of 2010 to 2050.

Methods

A Markov state transition model based on five fracture states was developed to estimate costs and loss of quality adjusted life years (QALYs). Demographic change was modelled using individual generation life tables. Direct (inpatient, outpatient, long-term care) and indirect fracture costs attributable to osteoporosis were estimated by comparing Markov cohorts with and without osteoporosis.

Results

The number of OAF will rise from 115,248 in 2010 to 273,794 in 2050, cumulating to approximately 8.1 million fractures (78 % women, 22 % men) during the period between 2010 and 2050. Total undiscounted incident OAF costs will increase from around 1.0 billion Euros in 2010 to 6.1 billion Euros in 2050. Discounted (3 %) cumulated costs from 2010 to 2050 will amount to 88.5 billion Euros (168.5 undiscounted), with 76 % being direct and 24 % indirect costs. The discounted (undiscounted) cumulated loss of QALYs will amount to 2.5 (4.9) million.

Conclusions

We found that incident OAF costs will sharply increase until the year 2050. As a consequence, a growing demand for long-term care as well as hospital care can be expected and should be considered in future healthcare planning. To support decision makers in managing the future burden of OAF, our model allows to economically evaluate population- and risk group-based interventions for fracture prevention in Germany.

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Notes

  1. Referring to cost ranges (± percent from mean costs) univariate distribution were used.

References

  1. Statistisches Bundesamt (2009) Bevölkerung Deutschland bis 2060. 12. koordinierte Bevölkerungsvorausberechnung [Population in Germany up to the year 2060. Results of the 12th coordinated projection of population]. Statistisches Bundesamt, Wiesbaden

    Google Scholar 

  2. Kanis JA, Johnell O, Oden A, Jonsson B, De Laet C, Dawson A (2000) Risk of hip fracture according to the World Health Organization criteria for osteopenia and osteoporosis. Bone 27:585–590

    Article  PubMed  CAS  Google Scholar 

  3. World Health Organisation (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser 843:1–129

    Google Scholar 

  4. Johnell O, Kanis JA, Oden A, Johansson H, De Laet C, Delmas P, Eisman JA, Fujiwara S, Kroger H, Mellstrom D, Meunier PJ, Melton LJ 3rd, O’Neill T, Pols H, Reeve J, Silman A, Tenenhouse A (2005) Predictive value of BMD for hip and other fractures. J Bone Miner Res 20:1185–1194

    Article  PubMed  Google Scholar 

  5. Marshall D, Johnell O, Wedel H (1996) Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 312:1254–1259

    Article  PubMed  CAS  Google Scholar 

  6. Stone KL, Seeley DG, Lui LY, Cauley JA, Ensrud K, Browner WS, Nevitt MC, Cummings SR (2003) BMD at multiple sites and risk of fracture of multiple types: long-term results from the Study of Osteoporotic Fractures. J Bone Miner Res 18:1947–1954

    Article  PubMed  Google Scholar 

  7. Osnes EK, Lofthus CM, Meyer HE, Falch JA, Nordsletten L, Cappelen I, Kristiansen IS (2004) Consequences of hip fracture on activities of daily life and residential needs. Osteoporos Int 15:567–574

    Article  PubMed  CAS  Google Scholar 

  8. Hiligsmann M, Ethgen O, Richy F, Reginster JY (2008) Utility values associated with osteoporotic fracture: a systematic review of the literature. Calcif Tissue Int 82:288–292

    Article  PubMed  CAS  Google Scholar 

  9. Morin S, Lix LM, Azimaee M, Metge C, Caetano P, Leslie WD (2011) Mortality rates after incident non-traumatic fractures in older men and women. Osteoporos Int 22:2439–2448

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  11. Konnopka A, Jerusel N, Konig HH (2009) The health and economic consequences of osteopenia- and osteoporosis-attributable hip fractures in Germany: estimation for 2002 and projection until 2050. Osteoporos Int 20:1117–1129

    Article  PubMed  CAS  Google Scholar 

  12. Häussler B, Gothe H, Gol D, Glaeske G, Pientka L, Felsenberg D (2007) Epidemiology, treatment and costs of osteoporosis in Germany—the BoneEVA Study. Osteoporos Int 18:77–84

    Article  PubMed  Google Scholar 

  13. Schwenkglenks M, Lippuner K, Hauselmann HJ, Szucs TD (2005) A model of osteoporosis impact in Switzerland 2000–2020. Osteoporos Int 16:659–667

    Article  PubMed  Google Scholar 

  14. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 22:465–475

    Article  PubMed  Google Scholar 

  15. Burge RT, Worley D, Johansen A, Bhattacharyya S, Bose U (2001) The cost of osteoporotic fractures in the UK: projections for 2000–2020. J Med Econ 4:51–62

    Article  Google Scholar 

  16. Tosteson AN, Jonsson B, Grima DT, O’Brien BJ, Black DM, Adachi JD (2001) Challenges for model-based economic evaluations of postmenopausal osteoporosis interventions. Osteoporos Int 12:849–857

    Article  PubMed  CAS  Google Scholar 

  17. Statistisches Bundesamt (2006) Generationensterbetafeln für Deutschland. Modellrechnungen für die Geburtsjahrgänge 1871–2004 [Generation life tables for Germany. A model calculation for the birth cohorts 1871–2004]. Statistisches Bundesamt, Wiesbaden

  18. Jerusel N (2009) Analyse und Prognose der Krankheitslast Osteoporose—attributabler proximaler Femurfrakturen in Deutschland [Analysis and Prognosis of the health burden of osteoporosis attributable proximal femur fractures in Germany]. University of Leipzig, Dissertation

    Google Scholar 

  19. Wildner M (2001) Osteoporose [Osteoporosis]. Dtsch med Wochenschr 126:A1170–A1172

    Google Scholar 

  20. Konig HH, Barry JC (2004) Cost–utility analysis of orthoptic screening in kindergarten: a Markov model based on data from Germany. Pediatrics 113:e95–e108

    Article  PubMed  Google Scholar 

  21. Paggiosi M, Glueer C, Roux C, Reid D, Felsenberg D, Barkmann R, Eastell R (2011) International variation in proximal femur bone mineral density. Osteoporos Int 22:721–729

    Article  PubMed  CAS  Google Scholar 

  22. Looker AC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP, Johnston CC Jr, Lindsay R (1998) Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int 8:468–489

    Article  PubMed  CAS  Google Scholar 

  23. Statistisches Bundesamt (2011) Tiefgegliederte Diagnosedaten der Krankenhauspatientinnen und -patienten 2009 [Deep stratified diagnosis—data from female and male inpatients 2009]. Statistisches Bundesamt, Wiesbaden

    Google Scholar 

  24. Gedeborg R, Engquist H, Berglund L, Michaelsson K (2008) Identification of incident injuries in hospital discharge registers. Epidemiology 19:860–867

    Article  PubMed  Google Scholar 

  25. Icks A, Haastert B, Wildner M, Becker C, Meyer G (2008) Trend of hip fracture incidence in Germany 1995–2004: a population-based study. Osteoporos Int 19:1139–1145

    Article  PubMed  CAS  Google Scholar 

  26. Finnern HW, Sykes DP (2003) The hospital cost of vertebral fractures in the EU: estimates using national datasets. Osteoporos Int 14:429–436

    Article  PubMed  Google Scholar 

  27. Oleksik A, Lips P, Dawson A, Minshall ME, Shen W, Cooper C, Kanis J (2000) Health-related quality of life in postmenopausal women with low BMD with or without prevalent vertebral fractures. J Bone Miner Res 15:1384–1392

    Article  PubMed  CAS  Google Scholar 

  28. Einsiedel T, Becker C, Stengel D, Schmelz A, Kramer M, Daxle M, Lechner F, Kinzl L, Gebhard F (2006) Do injuries of the upper extremity in geriatric patients end up in helplessness? A prospective study for the outcome of distal radius and proximal humerus fractures in individuals over 65. Z Gerontol Geriatr 39:451–461

    Article  PubMed  CAS  Google Scholar 

  29. Boufous S, Finch C, Close J, Day L, Lord S (2007) Hospital admissions following presentations to emergency departments for a fracture in older people. Inj Prev 13:211–214

    Article  PubMed  Google Scholar 

  30. Van Staa TP, Leufkens HG, Cooper C (2002) Does a fracture at one site predict later fractures at other sites? A British cohort study. Osteoporos Int 13:624–629

    Article  PubMed  Google Scholar 

  31. Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739

    Article  PubMed  CAS  Google Scholar 

  32. Kanis JA, Borgstrom F, Johnell O, Jonsson B (2004) Cost-effectiveness of risedronate for the treatment of osteoporosis and prevention of fractures in postmenopausal women. Osteoporos Int 15:862–871

    Article  PubMed  CAS  Google Scholar 

  33. Johnell O, Kanis JA, Oden A, Sernbo I, Redlund-Johnell I, Petterson C, De Laet C, Jonsson B (2004) Mortality after osteoporotic fractures. Osteoporos Int 15:38–42

    Article  PubMed  CAS  Google Scholar 

  34. Konig HH, Bernert S, Angermeyer MC (2005) Health Status of the German population: results of a representative survey using the EuroQol questionnaire. Gesundheitswesen 67:173–182

    Article  PubMed  CAS  Google Scholar 

  35. Dolan P (1997) Modeling valuations for EuroQol health states. Med Care 35:1095–1108

    Article  PubMed  CAS  Google Scholar 

  36. Kanis JA, Johnell O, Oden A, Borgstrom F, Zethraeus N, De Laet C, Jonsson B (2004) The risk and burden of vertebral fractures in Sweden. Osteoporos Int 15:20–26

    Article  PubMed  CAS  Google Scholar 

  37. Institut für das Entgeltsystem im Krankenhaus (INEK) (2011) G-DRG V2010 Browser. Institut für das Entgeltsystem im Krankenhaus, Siegburg

    Google Scholar 

  38. Deutsche Krankenhausgesellschaft (2011) Landesbasisfallwerte der Bundesländer 2005–2011 [Base rates of the German Federal States 2005–2011]. http://www.dkgev.de/media/file/7827.LBFW_2005_2010_Stand_160610.pdf. Accessed 18 Feb 2012

  39. Krauth C, Hessel F, Hansmeier T, Wasem J, Seitz R, Schweikert B (2005) Empirical standard costs for health economic evaluation in Germany—a proposal by the working group methods in health economic evaluation. Gesundheitswesen 67:736–746

    Article  PubMed  CAS  Google Scholar 

  40. Kreck S, Klaus J, Leidl R, von Tirpitz C, Konnopka A, Matschinger H, Konig HH (2008) Cost effectiveness of ibandronate for the prevention of fractures in inflammatory bowel disease-related osteoporosis: cost-utility analysis using a Markov model. Pharmacoeconomics 26:311–328

    Article  PubMed  Google Scholar 

  41. Kassenärztliche Bundesvereinigung (KBV) (2010) Einheitlicher Bewertungsmaßstab (EBM) 2010. http://www.kbv.de/ebm2012/EBMGesamt.htm. Accessed 18 Feb 2012

  42. Rote Liste Service GmbH (2009) Rote Liste 2009 [Red List 2009]. Rote Liste Service GmbH, Frankfurt am Main

    Google Scholar 

  43. Statistisches Bundesamt (2011) Pflegestatistik 2009. Pflege im Rahmen der Pflegeversicherung. Deutschlandergebnisse [Statistics on care 2009—care in the context of the care insurance results from Germany]. Statistisches Bundesamt, Wiesbaden

    Google Scholar 

  44. Bundesverband AOK (2009) Krankheitsartenstatistik 2008 [Disease statistic 2008]. AOK Bundesverband, Berlin

    Google Scholar 

  45. Deutsche Rentenversicherung (2010) Statistik der Deutschen Rentenversicherung. Rehabilitation 2009 Band 179 [Statistic of the German pension insurance fund—rehabilitation 2009 volume 179]. Deutsche Rentenversicherung, Berlin

    Google Scholar 

  46. Statistisches Bundesamt (2011) Verdienste und Arbeitskosten, Jahr 2010, Fachserie 16 Reihe 2.3 [Earning and labour cost 2010, Series 16(2.3)]. Statistisches Bundesamt, Wiesbaden

    Google Scholar 

  47. Statistisches Bundesamt (2009) Mikrozenus 2009, Fachserie 1 Reihe 4.1.1 [Microcensus 2009, Series 1(4.1.1)]. Statistisches Bundesamt, Wiesbaden

    Google Scholar 

  48. Statistisches Bundesamt (2003) Wo bleibt die Zeit? Die Zeitverwendung der Bevölkerung in Deutschland 2001/02 [Where has the time gone? The time use of the German population in 2001/02]. Statistisches Bundesamt, Wiesbaden

    Google Scholar 

  49. Briggs A, Claxton K, Sculpher M (2007) Decision modelling for health economic evaluation. Oxford University, Oxford

    Google Scholar 

  50. Statistisches Bundesamt (2012) Die Gesundheitsberichterstattung des Bundes: Ausgaben, Kosten, Finanzierung [Federal health monitoring: expenditures, costs and financing].https://www.gbebund.de/gbe10/abrechnung.prc_abr_test_logon?p_uid=gast&p_aid=51115479&p_sprache=E&p_knoten=TR19200. Accessed 15 April 2012

  51. Nguyen ND, Center JR, Eisman JA, Nguyen TV (2007) Bone loss, weight loss, and weight fluctuation predict mortality risk in elderly men and women. J Bone Miner Res 22:1147–1154

    Article  PubMed  Google Scholar 

  52. Melton LJ 3rd, Thamer M, Ray NF, Chan JK, Chesnut CH 3rd, Einhorn TA, Johnston CC, Raisz LG, Silverman SL, Siris ES (1997) Fractures attributable to osteoporosis: report from the National Osteoporosis Foundation. J Bone Miner Res 12:16–23

    Article  PubMed  Google Scholar 

  53. Mackey DC (2011) Determining which fractures are osteoporotic: empirical associations would provide better evidence than expert opinion. J Clin Epidemiol 64:45

    Article  PubMed  Google Scholar 

  54. Cooper C, Cole ZA, Holroyd CR, Earl SC, Harvey NC, Dennison EM, Melton LJ, Cummings SR, Kanis JA (2011) Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int 22:1277–1288

    Article  PubMed  CAS  Google Scholar 

  55. Oxford Centre of Evidence-Based Medicine (2009) Levels of evidence (March 2009). http://www.cebm.net/index.aspx?o=1025. Accessed 18 Feb 2012

  56. Mueller D, Gandjour A (2009) Cost-effectiveness of using clinical risk factors with and without DXA for osteoporosis screening in postmenopausal women. Value Health 12:1106–1117

    Article  PubMed  Google Scholar 

  57. Kennedy CC, Papaioannou A, Adachi JD (2006) Treating osteoporosis: economic aspects of bisphosphonate therapy. Expert Opin Pharmacother 7:1457–1467

    Article  PubMed  CAS  Google Scholar 

  58. Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767

    Article  PubMed  Google Scholar 

  59. Becker C, Cameron ID, Klenk J, Lindemann U, Heinrich S, Konig HH, Rapp K (2011) Reduction of femoral fractures in long-term care facilities: the Bavarian fracture prevention study. PLoS One 6:e24311

    Article  PubMed  CAS  Google Scholar 

  60. Cameron ID, Murray GR, Gillespie LD, Robertson MC, Hill KD, Cumming RG, Kerse N (2010) Interventions for preventing falls in older people in nursing care facilities and hospitals. Cochrane Database Syst Rev 20:CD005465

    Google Scholar 

  61. Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH (2009) Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev CD007146

  62. Davis JC, Robertson MC, Ashe MC, Liu-Ambrose T, Khan KM, Marra CA (2009) Does a home-based strength and balance programme in people aged > or =80 years provide the best value for money to prevent falls? A systematic review of economic evaluations of falls prevention interventions. Br J Sports Med 44:80–89

    Article  Google Scholar 

  63. Church J, Goodall S, Norman R, Haas M (2011) An economic evaluation of community and residential aged care falls prevention strategies in NSW. N S W Public Health Bull 22:60–68

    Article  PubMed  Google Scholar 

  64. Gandjour A, Weyler EJ (2008) Cost-effectiveness of preventing hip fractures by hip protectors in elderly institutionalized residents in Germany. Value Health 11:1088–1095

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was funded by the German Federal Ministry of Education and Research (BMBF), Germany, FKZ:01EC1007C. Petra Benzinger and Kilian Rapp were supported by a grant from the “Forschungskolleg Geriatrie” of the Robert Bosch Foundation. The BMBF and the Robert Bosch Foundation had no further role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

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Authors and Affiliations

  1. Department for Medical Sociology and Health Economics, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany

    F. Bleibler, A. Konnopka & H.-H. König

  2. Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstraße 110, 70376, Stuttgart, Germany

    P. Benzinger & K. Rapp

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  1. F. Bleibler
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Correspondence to F. Bleibler.

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Bleibler, F., Konnopka, A., Benzinger, P. et al. The health burden and costs of incident fractures attributable to osteoporosis from 2010 to 2050 in Germany—a demographic simulation model. Osteoporos Int 24, 835–847 (2013). https://doi.org/10.1007/s00198-012-2020-z

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