Osteoporosis International

, Volume 17, Issue 5, pp 637–650 | Cite as

Costs and quality of life associated with osteoporosis-related fractures in Sweden

  • Fredrik Borgström
  • Niklas Zethraeus
  • Olof Johnell
  • Lars Lidgren
  • Sari Ponzer
  • Olle Svensson
  • Peter Abdon
  • Ewald Ornstein
  • Karl Lunsjö
  • Karl Göran Thorngren
  • Ingemar Sernbo
  • Clas Rehnberg
  • Bengt Jönsson
Original Article

Abstract

This prospective observational data collection study assessed the cost and quality of life related to hip, vertebral and wrist fracture 1 year after the fracture, based on a patient sample consisting of 635 male and female patients surviving a year after fracture. Data regarding resource use and quality of life related to fractures was collected by questionnaires at baseline, 4 months and 12 months. Information was collected by the use of patients’ records, register sources and by asking the patient. Quality of life was estimated with the EQ-5D questionnaire. Costs were estimated from a societal perspective, including direct and indirect costs. The mean fracture-related cost the year after a hip, vertebral and wrist fracture were estimated, in euros (€), at €14,221, €12,544 and €2,147, respectively [converted from Swedish krona (SEK) at an exchange rate of 9.1268 SEK/€]. The mean reduction in quality of life was estimated at 0.17, 0.26 and 0.06 for hip, vertebral and wrist fracture, respectively. Based on the results, the yearly burden of osteoporosis in Sweden could be estimated at €0.5 billion (SEK 4.6 billion). The patient sample for vertebral fracture was fairly small and included a high proportion of fractures leading to hospitalization, but they indicate a higher cost and loss of quality of life related to vertebral fracture than previously perceived.

Keywords

Costs Fracture Osteoporosis Quality of life 

References

  1. 1.
    Osteoporos—prevention, diagnostik och behandling (2003). StockholmGoogle Scholar
  2. 2.
    Lippuner K, Golder M, Greiner R (2005) Epidemiology and direct medical costs of osteoporotic fractures in men and women in Switzerland. Osteoporos Int 16 [Suppl 2]:S8–S17CrossRefPubMedGoogle Scholar
  3. 3.
    Wong MK, Arjandas, Ching LK, Lim SL, Lo NN (2002) Osteoporotic hip fractures in Singapore—costs and patients’ outcome. Ann Acad Med Singapore 31:3–7PubMedGoogle Scholar
  4. 4.
    Gabriel SE, Tosteson AN, Leibson CL, Crowson CS, Pond GR, Hammond CS, Melton LJ 3rd (2002) Direct medical costs attributable to osteoporotic fractures. Osteoporos Int 13:323–330CrossRefPubMedGoogle Scholar
  5. 5.
    Koeck CM, Schwappach DL, Niemann FM, Strassmann TJ, Ebner H, Klaushofer K (2001) Incidence and costs of osteoporosis-associated hip fractures in Austria. Wien Klin Wochenschr 113:371–377PubMedGoogle Scholar
  6. 6.
    Wiktorowicz ME, Goeree R, Papaioannou A, Adachi JD, Papadimitropoulos E (2001) Economic implications of hip fracture: health service use, institutional care and cost in Canada. Osteoporos Int 12:271–278CrossRefPubMedGoogle Scholar
  7. 7.
    Reginster JY, Gillet P, Ben Sedrine W, Brands G, Ethgen O, de Froidmont C, Gosset C (1999) Direct costs of hip fractures in patients over 60 years of age in Belgium. Pharmacoeconomics 15:507–514CrossRefPubMedGoogle Scholar
  8. 8.
    Zethraeus N, Gerdtham UG (1998) Estimating the costs of hip fracture and potential savings. Int J Technol Assess Health Care 14:255–267PubMedCrossRefGoogle Scholar
  9. 9.
    Dolan P, Torgerson DJ (1998) The cost of treating osteoporotic fractures in the United Kingdom female population. Osteoporos Int 8:611–617CrossRefPubMedGoogle Scholar
  10. 10.
    Zethraeus N, Stromberg L, Jonsson B, Svensson O, Ohlen G (1997) The cost of a hip fracture. Estimates for 1,709 patients in Sweden. Acta Orthop Scand 68:13–17PubMedCrossRefGoogle Scholar
  11. 11.
    Chrischilles E, Shireman T, Wallace R (1994) Costs and health effects of osteoporotic fractures. Bone 15:377–386CrossRefPubMedGoogle Scholar
  12. 12.
    Nurmi I, Narinen A, Luthje P, Tanninen S (2003) Cost analysis of hip fracture treatment among the elderly for the public health services: a 1-year prospective study in 106 consecutive patients. Arch Orthop Trauma Surg 123:551–554CrossRefPubMedGoogle Scholar
  13. 13.
    Holmberg S, Thorngren KG (1988) Consumption of hospital resources for femoral neck fracture. Acta Orthop Scand 59:377–381PubMedGoogle Scholar
  14. 14.
    Borgquist L, Lindelow G, Thorngren KG (1991) Costs of hip fracture. Rehabilitation of 180 patients in primary health care. Acta Orthop Scand 62:39–48PubMedGoogle Scholar
  15. 15.
    Haentjens P, Autier P, Barette M, Boonen S (2001) The economic cost of hip fractures among elderly women. A one-year, prospective, observational cohort study with matched-pair analysis. Belgian Hip Fracture Study Group. J Bone Joint Surg Am 83A:493–500Google Scholar
  16. 16.
    De Laet CE, van Hout BA, Burger H, Weel AE, Hofman A, Pols HA (1999) Incremental cost of medical care after hip fracture and first vertebral fracture: the Rotterdam study. Osteoporos Int 10:66–72PubMedCrossRefGoogle Scholar
  17. 17.
    Zethraeus N, Borgström F, Johnell O, Kanis J, Jönsson B(2002) Costs and quality of life associated with osteoporosis related fractures—results from a Swedish Survey. Stockholm School of Economics, StockholmGoogle Scholar
  18. 18.
    Statistics Sweden. Sweden’s statistical databases. http://www.scbse/eng/databaser/ssdasp
  19. 19.
    Sveriges Riksbank. Average exchange rates. http://wwwd.riksbank.com. Accessed 13 May 2005
  20. 20.
    Janzon M, Levin LA, Swahn E (2002) Cost-effectiveness of an invasive strategy in unstable coronary artery disease; results from the FRISC II invasive trial. The fast revascularisation during instability in coronary artery disease trial. Eur Heart J 23:31–40CrossRefPubMedGoogle Scholar
  21. 21.
    Apoteket (Swedish national pharmacy). Apotekets varuregister. December 2003, StockholmGoogle Scholar
  22. 22.
    http://www.stockholm.se Stadsledningskontorets redovisningsstab. Stockholms stads budgetavräkning
  23. 23.
    Region Skånes revisorer. Granskning av Skånetrafikens upphandling, 2004. http://www.skane.se/upload/Webbplatser/Revisionen/Dokument/Granskningsrapporter/RapportSkanetrafiken040304.pdf. Accessed 15 January 2005
  24. 24.
    Average hourly prices in the private sector. Statistiska Centralbyån (Statistics Sweden). http://www.ssd.scb.se/databaser/makro/MainTable.asp?yp=tansss&xu=C9233001&omradekod=AM&omradetext=Arbetsmarknad&lang=1 Accessed 11 January 2005
  25. 25.
    Drummond M, O’Brien B, Stoddart G, Torrance G (1997) Methods for the economic evaluation of health care programmes. Oxford University Press, OxfordGoogle Scholar
  26. 26.
    Gold M, Siegel J, Russell L (eds) (1996) Cost-effectiveness in health and medicine. Oxford University Press, New YorkGoogle Scholar
  27. 27.
    Vägverket. Vägverkets samhällsekonomiska kalkymodell. Ekonomisk teori och värderingar (1997) Vägverket (Swedish Road Authority), StockholmGoogle Scholar
  28. 28.
    Brooks R (1996) EuroQol: the current state of play. Health Policy 37:53–72CrossRefPubMedGoogle Scholar
  29. 29.
    Dolan P (1997) Modeling valuations for EuroQol health states. Med Care 35:1095–1108CrossRefPubMedGoogle Scholar
  30. 30.
    Burstrom K, Johannesson M, Diderichsen F (2001) Swedish population health-related quality of life results using the EQ-5D. Qual Life Res 10:621–635CrossRefPubMedGoogle Scholar
  31. 31.
    Wackerly DD, Mendenhall W, Schaeffer RL (1996) Mathematical statistics with applications. Duxbury Press, BelmontGoogle Scholar
  32. 32.
    Briggs AH, Wonderling DE, Mooney CZ (1997) Pulling cost-effectiveness analysis up by its bootstraps: a non-parametric approach to confidence interval estimation. Health Econ 6:327–340PubMedCrossRefGoogle Scholar
  33. 33.
    Neter J, Kutner MH, Nachtsheim CJ, Wasserman W (1996) Applied linear statistical models. McGraw-Hill, ChicagoGoogle Scholar
  34. 34.
    Gujarati DN (2003) Basic econometrics. McGraw-Hill, New YorkGoogle Scholar
  35. 35.
    Johnell O, Kanis JA, Jonsson B, Oden A, Johansson H, De Laet C (2005) The burden of hospitalised fractures in Sweden. Osteoporos Int 16:222–228CrossRefPubMedGoogle Scholar
  36. 36.
    Eurostat. purchasing power parities (PPP) and comparative price level indices for the ESA95 aggregates. http://www.epp.eurostat.cec.eu.int/portal/page?_pageid=0,1136173,0_45570701&_dad=portal&_schema=PORTAL. Accessed 31 August 2005
  37. 37.
    Borgstrom F, Johnell O, Kanis JA, Oden A, Sykes D, Jonsson B (2004) Cost effectiveness of raloxifene in the treatment of osteoporosis in Sweden: an economic evaluation based on the MORE study. Pharmacoeconomics 22:1153–1165CrossRefPubMedGoogle Scholar
  38. 38.
    Johnell O, Jonsson B, Jonsson L, Black D (2003) Cost effectiveness of alendronate (Fosamax) for the treatment of osteoporosis and prevention of fractures. Pharmacoeconomics 21:305–314CrossRefPubMedGoogle Scholar
  39. 39.
    Jonsson B, Christiansen C, Johnell O, Hedbrandt J (1995) Cost-effectiveness of fracture prevention in established osteoporosis. Osteoporos Int 5:136–142CrossRefPubMedGoogle Scholar
  40. 40.
    Tosteson AN, Gabriel SE, Grove MR, Moncur MM, Kneeland TS, Melton LJ 3rd (2001) Impact of hip and vertebral fractures on quality adjusted life years. Osteoporos Int 12:1042–1049PubMedCrossRefGoogle Scholar
  41. 41.
    Gabriel SE, Kneeland TS, Melton LJ 3rd, Moncur MM, Ettinger B, Tosteson AN (1999) Health-related quality of life in economic evaluations for osteoporosis: whose values should we use? Med Decis Making 19:141–148PubMedCrossRefGoogle Scholar
  42. 42.
    Salkeld G, Cameron ID, Cumming RG, Easter S, Seymour J, Kurrle SE, Quine S (2000) Quality of life related to fear of falling and hip fracture in older women: a time trade off study. BMJ 320:341–346CrossRefPubMedGoogle Scholar
  43. 43.
    Brazier JE, Green C, Kanis JA (2002) A systematic review of health state utility values for osteoporosis-related conditions. Osteoporos Int 13:768–776CrossRefPubMedGoogle Scholar
  44. 44.
    Tidermark J, Zethraeus N, Svensson O, Tornkvist H, Ponzer S (2002) Femoral neck fractures in the elderly: functional outcome and quality of life according to EuroQol. Qual Life Res 11:473–481CrossRefPubMedGoogle Scholar
  45. 45.
    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 15:1384–1392PubMedCrossRefGoogle Scholar
  46. 46.
    Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B (2004) Excess mortality after hospitalisation for vertebral fracture. Osteoporos Int 15:108–112PubMedCrossRefGoogle Scholar
  47. 47.
    Dolan P, Torgerson D, Kakarlapudi TK (1999) Health-related quality of life of Colles’ fracture patients. Osteoporos Int 9:196–199CrossRefPubMedGoogle Scholar
  48. 48.
    Henriksson F, Agardh CD, Berne C, Bolinder J, Lonnqvist F, Stenstrom P, Ostenson CG, Jonsson B (2000) Direct medical costs for patients with type 2 diabetes in Sweden. J Intern Med 248:387–396CrossRefPubMedGoogle Scholar
  49. 49.
    Henriksson F, Fredrikson S, Masterman T, Jonsson B (2001) Costs, quality of life and disease severity in multiple sclerosis: a cross-sectional study in Sweden. Eur J Neurol 8:27–35CrossRefPubMedGoogle Scholar
  50. 50.
    Ekman M, Zethraeus N, Dahlström U, Höglund C (2002) Är behandling av hjärtsvikt med betablockerare kostnadseffektiv? Läkartidningen 99Google Scholar
  51. 51.
    Eichler HG, Kong SX, Gerth WC, Mavros P, Jonsson B (2004) Use of cost-effectiveness analysis in health-care resource allocation decision-making: how are cost-effectiveness thresholds expected to emerge? Value Health 7:518–528CrossRefPubMedGoogle Scholar
  52. 52.
    Kostnad per vårdtillfälle, vårddag och läkarbesök på sjukhus 2001. http://www.lf.se/sek/tankstation.htm, Landstingsförbundet, Stockholm
  53. 53.
    Sydöstra sjukvårdsregionen, 2004 [online]. http://www.lio.se/utm/gen1.asp?ArticleId=23077. Accessed 23 December 2004
  54. 54.
    Uppsala Akademiska Sjukhus, 2004 [online]. http://www.lul.se/svn/. Accessed 14 May 2004
  55. 55.
    Norrlands universitetssjukhus, 2004 [online]. http://www.norrlandstingen.nu/nuspri04utg2.xls. Accessed 23 December 2004
  56. 56.
    Universitetssjukhuset MAS, 2004 [online]. http://www.srvn.org/prislista.htm. Accessed 23 December 2004
  57. 57.
    Universitetssjukhuset i Lund, 2004 [online]. http://www.srvn.org/prislista.htm. Accessed 23 December 2004
  58. 58.
    Nyköping lasarett, 2004 [online]. http://www.lul.se/svn/. Accessed 14 May 2004
  59. 59.
    Mälarsjukhuset, 2004 [online]. http://www.lul.se/svn/. Accessed 14 May 2004
  60. 60.
    Huddinge Universitetssjukhus, 2004 [online]. http://www.extern.bkv.sll.se/samv.sthlm–gotland/. Accessed 10 September 2004
  61. 61.
    Karolinska Univeristetssjukhuset, 2004 [online]. http://www.extern.bkv.sll.se/samv.sthlm–gotland/. Accessed 9 September 2004
  62. 62.
    Västra Sjukvårdsregionen, 2004 [online]. http://www.vgregion.se/upload/svn%20–%20samverkansnämden/utomlanspriser_2004.pdf. Accessed 28 June 2004
  63. 63.
    Universitetssjukhuset i írebro, 2004 [online]. http://www.lul.se/svn/. Accessed 14 May 2004
  64. 64.
    Stockholms stads budgetavräkning 2003 [online]. http://www.stockholm.se/files/71600–71699/file_71645.pdf. Accessed 20 December 2004

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2005

Authors and Affiliations

  • Fredrik Borgström
    • 1
    • 2
  • Niklas Zethraeus
    • 3
  • Olof Johnell
    • 4
  • Lars Lidgren
    • 5
  • Sari Ponzer
    • 6
  • Olle Svensson
    • 7
  • Peter Abdon
    • 8
  • Ewald Ornstein
    • 9
  • Karl Lunsjö
    • 10
  • Karl Göran Thorngren
    • 5
  • Ingemar Sernbo
    • 4
  • Clas Rehnberg
    • 1
  • Bengt Jönsson
    • 3
  1. 1.Medical Management Centre, Karolinska InstitutetStockholmSweden
  2. 2.Stockholm Health EconomicsStockholmSweden
  3. 3.Stockholm School of EconomicsStockholmSweden
  4. 4.Department of OrthopaedicsMalmö General HospitalMalmöSweden
  5. 5.Department of OrthopaedicsLund UniversityLundSweden
  6. 6.Department of OrthopaedicsStockholm Söder Hospital, Karolinska InstitutetStockholmSweden
  7. 7.Division of OrthopedicsUmeå University HospitalUmeåSweden
  8. 8.Department of OrthopedicsYstad HospitalYstadSweden
  9. 9.Department of OrthopedicsHässleholm-Kristianstad HospitalsHässleholmSweden
  10. 10.Department of OrthopaedicsHelsingborg HospitalHelsingborgSweden

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