Cost-equivalence of different osteoporotic fractures
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Among 985 Olmsted County, Minnesota, residents who experienced an osteoporotic fracture (distal forearm, humerus, clavicle/scapula/sternum, ribs, vertebrae, pelvis, hip, other femur or tibia/fibula [the latter in women only]), we estimated the incremental cost of direct medical care in the following year compared with age- and sex-matched controls without a fracture randomly sampled from the same community.
The overall median incremental (case minus control) cost in the succeeding year was $2390, with a particularly high incremental cost for hip fractures ($11,241). There was fair concordance between the incremental cost of the different fractures, relative to hip fracture alone, and the previously published disutility associated with each fracture type relative to hip fracture. Overall, the incremental cost for all osteoporotic fractures combined was 46% greater than that for hip fractures alone in women and 47% greater in men. This is consistent with the earlier report that overall morbidity from all osteoporotic fractures combined is 47% and 39% greater in women and men, respectively, than the morbidity attributable solely to hip fractures.
These data lend support to the notion that other osteoporotic fractures can be quantified relative to hip fracture on the basis of their cost, as well as their morbidity and mortality. This may simplify health economic analyses by allowing all fracture outcomes to be modeled relative to hip fractures (i.e., hip fracture 'equivalents') and will provide a more comprehensive assessment of osteoporosis outcomes than is possible by focusing only on hip fractures.
KeywordsCost analysis Epidemiology Forearm fracture Hip fracture Osteoporosis Vertebral fracture
We wish to thank Megan Maurer for help with the data analysis and Mary Roberts for assistance in preparing the manuscript.
- 1.Kanis JA and the WHO Study Group (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. Osteoporosis Int 4:368–381Google Scholar
- 2.Melton LJ III (2000) Who has osteoporosis? A conflict between clinical and public health perspectives. J Bone Miner Res 15:2309–2314Google Scholar
- 3.Kanis JA, Glüer C-C, for the Committee of Scientific Advisors, International Osteoporosis Foundation (2000) An update on the diagnosis and assessment of osteoporosis with densitometry. Osteoporosis Int 11:192–202Google Scholar
- 4.Kanis JA, Black D, Cooper C et al on behalf of the International Osteoporosis Foundation and the National Osteoporosis Foundation, USA (2002) A new approach to the development of assessment guidelines for osteoporosis. Osteoporosis Int 13:527–536Google Scholar
- 5.Kanis JA, Johnell O, Oden A, Dawson A, De Laet C, Jonsson B (2001) Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporosis Int 12:989–995Google Scholar
- 6.Kanis JA, Oden A, Johnell O, Jonsson B, De Laet C, Dawson A (2001) The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporosis Int 12:417–427Google Scholar
- 7.Melton LJ III, Crowson CS, O'Fallon WM (1999) Fracture incidence in Olmsted County, Minnesota: comparison of urban with rural rates and changes in urban rates over time. Osteoporosis Int 9:29–37Google Scholar
- 8.Commission on Professional and Hospital Activities (1978) International classification of diseases, 9th revision clinical modification, Vol 1 diseases tabular list. CPHA, Ann ArborGoogle Scholar
- 9.Cooper C, Atkinson EJ, O'Fallon WM, Melton LJ III (1992) Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985–1989. J Bone Miner Res 7:221–227Google Scholar
- 10.Melton LJ III (1996) History of the Rochester Epidemiology Project. Mayo Clin Proc 71:266–274Google Scholar
- 11.Leibson CL, Hu T, Brown RD, Hass SL, O'Fallon WM, Whisnant JP (1996) Utilization of acute care services in the year before and after first stroke: a population-based study. Neurology 46:861–869Google Scholar
- 12.Gabriel SE, Tosteson ANA, Leibson CL, Crowson CS, Pond GR, Hammond CS, Melton LJ III (2002) Direct medical costs attributable to osteoporotic fractures. Osteoporosis Int 13:323–330Google Scholar
- 13.Melton LJ III (1997) The threat to medical-records research. N Engl J Med 337:1466–1470Google Scholar
- 14.Eddy D, Johnston CC, Cummings SR, Dawson-Hughes B, Lindsay R, Melton LJ III, Slemenda CW (1998) Osteoporosis: review of the evidence for prevention, diagnosis, and treatment and cost-effectiveness analysis. Osteoporosis Int 8 [Suppl 4]:1–88Google Scholar
- 15.Ray NF, Chan JK, Thamer M, Melton LJ III (1997) Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res 12:24–35Google Scholar
- 16.Greendale GA, Barrett-Connor E, Ingles S, Haile R (1995) Late physical and functional effects of osteoporotic fracture in women: the Rancho Bernardo Study. J Am Geriatr Soc 43:955–961Google Scholar
- 17.Tosteson ANA (1999) Economic impact of fractures. In: Orwoll E (ed) The effects of gender on skeletal health. Academic Press, San Diego, pp 15–27Google Scholar
- 18.Leibson CL, Naessens JM, Campion ME, Krishan I, Ballard DJ (1991) Trends in elderly hospitalization and readmission rates for a geographically defined population: pre- and post-prospective payment. J Am Geriatr Soc 39:895–904Google Scholar
- 19.Campion M, Naessens J, Leibson CL, Shaller D, Ballard DJ (1992) The Olmsted County Benchmark Project: primary study findings and potential implications for corporate America. Mayo Clin Proc 67:5–14Google Scholar
- 20.Tosteson ANA, Gabriel SE, Grove MR, Moncur MM, Kneeland TS, Melton LJ III (2001) Impact of hip and vertebral fractures on quality-adjusted life years. Osteoporosis Int 12:1042–1049Google Scholar