Indirect costs account for half of the total costs of an osteoporotic fracture: a prospective evaluation

Abstract

Summary

Data on direct and indirect costs of clinical fractures in 116 osteoporotic patients 50 years and older were prospectively collected using cost diaries. Indirect costs accounted for roughly half of the total costs, with a contribution of at least 81 % of these costs in employed patients.

Introduction

The aim of this prospective study was to gain insight into the current total costs of clinical fractures in osteoporotic patients aged 50 years and older.

Methods

In a study in the Netherlands, patients prospectively filled out cost diaries every 3 months, during 1 year after a clinical fracture. Primary analyses were performed on those patients with all four cost diaries returned. In-depth analyses of indirect costs were performed, dividing results for employed and unemployed patients. Sensitivity analyses using imputation techniques were performed on patients who returned two or three diaries

Results

Of the 116 included patients, 69 completed all four diaries, 24 only two or three, and 23 patient completed one or no diaries. For all fractures, approximately 50 % of the total costs were due to indirect costs; employed patients contributed for at least 81 % of the indirect cost. Humerus fractures were most expensive with a total 1-year cost of €16.841 per patient. Indirect costs in the group with clinical spine fractures were highest (€12.522), accounting for 89.1 % of the total costs for this fracture.

Conclusion

Indirect costs account for roughly half of the total costs of clinical fractures, which are largely related to sick leave. When performing cost analyses in fracture patients, we advise a societal perspective in which indirect costs are also considered, and to apply a patient derived prospective data collection method to get a ‘true’ and complete image of the total costs due to clinical fractures.

Appendix 1: cost diary

Complaints related to your fracture in the upcoming 3 months

• are you unable to perform paid work?

  Number of days sick leave	Total number of hours of sick leave
  E.g. 5 days	36 hours

• … are you unable to perform unpaid work? (e.g. voluntary work, housekeeping)

  Number of days	Total number of hours
  E.g. 2 days	4 hours

• … have you visited or consulted your general practitioner?

  Number of visits/consultations	Type of visit or consultation (consultation by telephone, at the practice or home visit by GP)
  E.g. 3 visits	Visit to the practice

• … have you received a medication prescription?

  Name of medication	Number of pills and dosage	Total used amount
  E.g. diclofenac	12 pills, 50 mg	3 pills a day during 4 days

• … have you purchased medication yourself? (e.g. acetaminophen)

  Name of medication	Number of pills and dosage	Total used amount
  E.g. ibuprofen	20 pillen van 400 mg	1 pill a day during 6 days

• … have you purchased other medical aids? (e.g. massage oil, brace)

  Date of purchase	Type of aid	Price
  E.g. May 30th	Brace	€ 85

• … have you visited a therapist? (e.g. physiotherapist, chiropractor)

  Number of visits	Type of therapist
  E.g. 10 visits	Physiotherapist

• … have you visited an alternative medicine specialist? (e.g. specialized in homeopathy, acupuncture)

  Number of visits	Type of therapist
  E.g. 2 visits	Acupuncturist

• … have you visited a specialist? (e.g. orthopedic surgeon, neurologist)

  Number of visits	Type of specialist
  E.g. 1 visit	Orthopedic surgeon

• … were radiological or laboratory tests done in the hospital? (e.g. X-ray, MRI-scan, blood test, DXA scan)

  Type of test	Number of tests
  e.g. X-ray	2

• …. have you been admitted to the hospital?

  Number of days	Which department?	What was the reason for admission?
  E.g. admitted for 5 days	Orthopedic surgery	Operation wrist

Room for remarks/costs that do not fit into the tables:

(please be as specific as possible when describing the costs).

Thank you for filling out these forms!!!

Please send this diary as soon as you have completed it

Appendix 2

Table 4 Costs per unit healthcare resource used in relation to the fracture

Appendix 3

Table 5 Sensitivity analyses (n = 93), mean cost per patient in euro