PharmacoEconomics

, Volume 28, Issue 5, pp 395–409

Direct and Indirect Costs of Non-Vertebral Fracture Patients with Osteoporosis in the US

  • Crystal Pike
  • Howard G. Birnbaum
  • Matt Schiller
  • Hari Sharma
  • Russel Burge
  • Eric T. Edgell
Original Research Article

Abstract

Background: Osteoporosis is a condition marked by low bone mineral density and the deterioration of bone tissue. One of the main clinical and economic consequences of osteoporosis is skeletal fractures.

Objective: To assess the healthcare and work loss costs of US patients with non-vertebral (NV) osteoporotic fractures.

Methods: Privately insured (aged 18–64 years) and Medicare (aged ≥65 years) patients with osteoporosis (ICD-9-CM code: 733.0x) were identified during 1999–2006 using two claims databases. Patients with an NV fracture (femur, pelvis, lower leg, upper arm, forearm, rib or hip) were matched randomly on age, sex, employment status and geographic region to controls with osteoporosis and no fractures. Patient characteristics and annual healthcare costs were assessed over the year following the index fracture for privately insured (n = 4764) and Medicare (n = 48 742) beneficiaries (Medicare drug costs were estimated using multivariable models). Indirect (i.e. work loss) costs were calculated for a subset of privately insured, employed patients with available disability data (n = 1148). All costs were reported in $US, year 2006 values.

Results: In Medicare, mean incremental healthcare costs per NV fracture patient were $US13 387 ($US22 466 vs $US9079; p < 0.05). The most expensive patients had index fractures of the hip, multiple sites and femur (incremental costs of $US25 519, $US20 137 and $US19 403, respectively). Patients with NV non-hip (NVNH) fractures had incremental healthcare costs of $US7868 per patient ($US16 704 vs $US8836; p < 0.05). Aggregate annual incremental healthcare costs of NVNH patients in the Medicare research sample (n = 35 933) were $US282.7 million compared with $US204.1 million for hip fracture patients (n = 7997).

Among the privately insured, mean incremental healthcare costs per NV fracture patient were $US5961 ($US11 636 vs $US5675; p < 0.05). The most expensive patients had index fractures of the hip, multiple sites and pelvis (incremental costs of $US13 801, $US9642 and $US8164, respectively). Annual incremental healthcare costs per NVNH patient were $US5381 ($US11 090 vs $US5709; p < 0.05). Aggregate annual incremental healthcare costs of NVNH patients in the privately insured sample (n = 4478) were $US24.1 million compared with $US3.5 million for hip fracture patients (n = 255). Mean incremental work loss costs per NV fracture employee were $US1956 ($US4349 vs $US2393; p < 0.05). Among patients with available disability data, work loss accounted for 29.5% of total costs per NV fracture employee.

Conclusion: The cost burden of NV fracture patients to payers is substantial. Although hip fracture patients were more costly per patient in both Medicare and privately insured samples, NVNH fracture patients still had substantial incremental costs. Because NVNH patients accounted for a larger proportion of the fracture population, they were associated with greater aggregate incremental healthcare costs than hip fracture patients.

Supplementary material

40273_2012_28050395_MOESM1_ESM.pdf (110 kb)
Supplementary material, approximately 113 KB.

References

  1. 1.
    The World Health Organization Scientific Group. Prevention and management of osteoporosis [technical report series no. 921]. Geneva, Switzerland: WHO, 2003Google Scholar
  2. 2.
    National Osteoporosis Foundation. Osteoporosis fast facts [online]. Available from URL: http://www.nof.org/osteoporosis/diseasefacts.htm [Accessed 2009 Mar 6]
  3. 3.
    National Institute of Arthritis and Musculoskeletal and Skin Diseases. Fact sheets: osteoporosis overview [online]. Available from URL: http://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/default.asp [Accessed 2009 Mar 6]
  4. 4.
    Pasco JA, Sanders KM, Hoekstra FM, et al. The human cost of fracture. Osteoporos Int 2005 Dec; 16 (12): 2046–52PubMedCrossRefGoogle Scholar
  5. 5.
    Srivastava M, Deal C. Osteoporosis in elderly: prevention and treatment. Clin Geriatr Med 2002; 18: 529–55PubMedCrossRefGoogle Scholar
  6. 6.
    Burge R, Dawson-Hughes B, Solomon DH, et al. Incidence and economic burden of osteoporosis-related fractures in the United States, 20052025. J Bone Miner Res 2007; 22: 465–75PubMedCrossRefGoogle Scholar
  7. 7.
    Tosteson AN, Gabriel SE, Grove MR, et al. Impact of hip and vertebral fractures on quality-adjusted life years. Osteoporos Int 2001; 12: 1042–9PubMedCrossRefGoogle Scholar
  8. 8.
    Boonen S, Singer AJ. Osteoporosis management: impact of fracture type on cost and quality of life in patients at risk for fracture I. Curr Med Res Opin 2008; 24 (6): 1781–8PubMedCrossRefGoogle Scholar
  9. 9.
    Melton LJ, Gabriel SE, Crowson CS, et al. Cost-equivalence of different osteoporotic fractures. Osteoporos Int 2003; 14: 383–8PubMedCrossRefGoogle Scholar
  10. 10.
    Orsini LS, Rousculp MD, Long SR, et al. Health care utilization and expenditures in the United States: a study of osteoporosis- related fractures. Osteoporos Int 2005; 16: 359–71PubMedCrossRefGoogle Scholar
  11. 11.
    Ray NF, Chan JK, Thamer M, et al. Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res 1997; 10 (1): 24–35CrossRefGoogle Scholar
  12. 12.
    Melton LJ. Adverse outcomes of osteoporotic fractures in the general population. J Bone Miner Res 2003 Jun; 18 (6): 1139–41PubMedCrossRefGoogle Scholar
  13. 13.
    Ohlsfeldt RL, Borisov NN, Steer RL. Fragility fracturerelated direct medical costs in the first year following a nonvertebral fracture in a managed care setting. Osteoporosis Int 2006; 17: 252–8CrossRefGoogle Scholar
  14. 14.
    Centers for Medicare and Medicaid Services. Medicare enrollment — aged beneficiaries: as of July 2006 [online]. Available from URL: http://www.cms.hhs.gov/MedicareEnRpts/Downloads/06Aged.pdf [Accessed 2009 Mar 9]
  15. 15.
    National Economic Council/Domestic Policy Council. America’s seniors and Medicare: challenges for today and tomorrow [online]. Available from URL: http://clinton5.nara.gov/media/pdf/med_exec_summ_2000.pdf [Accessed 2009 Mar 9]
  16. 16.
    Purcell P. Older workers: employment and retirement trends. CRS report for Congress, updated September 7, 2007 [online]. Available from URL: http://opencrs.cdt.org/rpts/RL30629_20070907.pdf [Accessed 2009 Mar 9]
  17. 17.
    Owen RA, Melton 3rd LJ, Gallagher JC, et al. The national cost of acute care of hip fractures associated with osteoporosis. Clin Orthop Relat Res 1980 Jul-Aug; 150: 172–6PubMedGoogle Scholar
  18. 18.
    Martin BC, Chisholm MA, Kotzan JA. Isolating the cost of osteoporosis-related fracture for postmenopausal women: a population-based study. Gerontology 2001 Jan-Feb; 47 (1): 21–9PubMedCrossRefGoogle Scholar
  19. 19.
    Lindsay R, Burge RT, Strauss M. One year outcomes and costs following a vertebral fracture. Osteoporos Int 2005; 16: 78–85PubMedCrossRefGoogle Scholar
  20. 20.
    Chrischilles E, Shireman T, Wallace R. Costs and health effects of osteoporotic fractures. Bone 1994 Jul-Aug; 15 (4): 377–86PubMedCrossRefGoogle Scholar
  21. 21.
    King AB, Saag KG, Burge RT, et al. Fracture Reduction Affects Medicare Economics (FRAME): impact of increased osteoporosis diagnosis and treatment. Osteoporos Int 2005; 16: 1545–57PubMedCrossRefGoogle Scholar
  22. 22.
    Zethraeus N, Borgstrom F, Johnell O, et al. Costs and quality of life associated with osteoporosis related fractures: results from a Swedish survey [Working Paper Series in Economics and Finance 2002, no. 512; online]. Available from URL: http://swopec.hhs.se/hastef/abs/hastef0512.htm [Accessed 2009 Sep 10]
  23. 23.
    Levy P, Levy E, Audran M, et al. The cost of osteoporosis in men: the French situation. Bone 2002 Apr; 30 (4): 631–6PubMedCrossRefGoogle Scholar
  24. 24.
    Bouee S, Lafuma A, Fagnani F, et al. Estimation of direct unit costs associated with non-vertebral osteoporotic fractures in five European countries. Rheumatol Int 2006 Oct; 26 (12): 1063–72PubMedCrossRefGoogle Scholar
  25. 25.
    Chen Z, Maricic M, Aragaki AK, et al. Fracture risk increases after diagnosis of breast or other cancers in postmenopausal women: results from the Women’s Health Initiative. Osteoporos Int 2009 Apr; 20 (4): 527–36PubMedCrossRefGoogle Scholar
  26. 26.
    Abelson A. A review of Paget’s disease of bone with a focus on the efficacy and safety of zoledronic acid 5mg. Curr Med Res Opin 2008 Mar; 24 (3): 695–705PubMedCrossRefGoogle Scholar
  27. 27.
    Blouin S, Libouban H, Moreau MF, et al. Orchidectomy models of osteoporosis. Methods Mol Bio 2008; 455: 125–34CrossRefGoogle Scholar
  28. 28.
    Hasselman CT, Vogt MT, Stone KL, et al. Foot and ankle fractures in elderly white women: incidence and risk factors. J Bone Joint Surg Am 2003 May; 85-A (5): 820–4PubMedGoogle Scholar
  29. 29.
    Kaye RA. Insufficiency stress fractures of the foot and ankle in postmenopausal women. Foot Ankle Int 1998 Apr; 19 (4): 221–4PubMedGoogle Scholar
  30. 30.
    Siris ES, Miller PD, Barrett-Connor E, et al. Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausalwomen: results from theNational Osteoporosis Risk Assessment. JAMA 2001; 286: 2815–22PubMedCrossRefGoogle Scholar
  31. 31.
    Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40 (5): 373–83PubMedCrossRefGoogle Scholar
  32. 32.
    Romano PS, Roos LL, Jollis J. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data. J Clin Epidemiol 1993; 46 (10): 1075–9PubMedCrossRefGoogle Scholar
  33. 33.
    Akobundu E, Ju J, Blatt L, et al. Cost-of-illness studies: a review of current methods. Pharmacoeconomics 2006; 24 (9): 869–90PubMedCrossRefGoogle Scholar
  34. 34.
    Rousculp MD, Long SR, Wang S, et al. Economic burden of osteoporosis-related fractures in Medicaid. Value Health 2007; 10 (2): 144–52PubMedCrossRefGoogle Scholar
  35. 35.
    Gunter MJ, Beaton SJ, Brenneman SK, et al. Management of osteoporosis in women aged 50 and older with osteoporosis- related fractures in a managed care population. Dis Manag 2003 Summer; 6 (2): 83–91PubMedCrossRefGoogle Scholar
  36. 36.
    Sasser AC, Rousculp MD, Birnbaum HG, et al. Economic burden of osteoporosis, breast cancer, and cardiovascular disease among postmenopausal women in an employed population. Womens Health Issues 2005 May-Jun; 15 (3): 97–108PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2010

Authors and Affiliations

  • Crystal Pike
    • 1
  • Howard G. Birnbaum
    • 1
  • Matt Schiller
    • 1
  • Hari Sharma
    • 1
  • Russel Burge
    • 2
    • 3
  • Eric T. Edgell
    • 2
  1. 1.Analysis Group, IncBostonUSA
  2. 2.Eli Lilly and CompanyLilly Corporate CenterIndianapolisUSA
  3. 3.University of CincinnatiCincinnatiUSA

Personalised recommendations