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.
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Notes
The participating centers were: Södersjukhuset in Stockholm, Malmö University Hospital, Lund University Hospital, Norrlands University Hospital, The Hospital in Ystad, Helsingborg Hospital and Hässleholm Hospital.
The following pharmaceutical categories were included: calcium and vitamin D, estrogens, bisphosphonates, glucocorticoids and pain medication.
References
Osteoporos—prevention, diagnostik och behandling (2003). Stockholm
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–S17
Wong MK, Arjandas, Ching LK, Lim SL, Lo NN (2002) Osteoporotic hip fractures in Singapore—costs and patients’ outcome. Ann Acad Med Singapore 31:3–7
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 13:323–330
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 113:371–377
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 12:271–278
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 15:507–514
Zethraeus N, Gerdtham UG (1998) Estimating the costs of hip fracture and potential savings. Int J Technol Assess Health Care 14:255–267
Dolan P, Torgerson DJ (1998) The cost of treating osteoporotic fractures in the United Kingdom female population. Osteoporos Int 8:611–617
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 68:13–17
Chrischilles E, Shireman T, Wallace R (1994) Costs and health effects of osteoporotic fractures. Bone 15:377–386
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 123:551–554
Holmberg S, Thorngren KG (1988) Consumption of hospital resources for femoral neck fracture. Acta Orthop Scand 59:377–381
Borgquist L, Lindelow G, Thorngren KG (1991) Costs of hip fracture. Rehabilitation of 180 patients in primary health care. Acta Orthop Scand 62:39–48
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:493–500
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 10:66–72
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, Stockholm
Statistics Sweden. Sweden’s statistical databases. http://www.scbse/eng/databaser/ssdasp
Sveriges Riksbank. Average exchange rates. http://wwwd.riksbank.com. Accessed 13 May 2005
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 23:31–40
Apoteket (Swedish national pharmacy). Apotekets varuregister. December 2003, Stockholm
http://www.stockholm.se Stadsledningskontorets redovisningsstab. Stockholms stads budgetavräkning
Region Skånes revisorer. Granskning av Skånetrafikens upphandling, 2004. http://www.skane.se/upload/Webbplatser/Revisionen/Dokument/Granskningsrapporter/RapportSkanetrafiken040304.pdf. Accessed 15 January 2005
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
Drummond M, O’Brien B, Stoddart G, Torrance G (1997) Methods for the economic evaluation of health care programmes. Oxford University Press, Oxford
Gold M, Siegel J, Russell L (eds) (1996) Cost-effectiveness in health and medicine. Oxford University Press, New York
Vägverket. Vägverkets samhällsekonomiska kalkymodell. Ekonomisk teori och värderingar (1997) Vägverket (Swedish Road Authority), Stockholm
Brooks R (1996) EuroQol: the current state of play. Health Policy 37:53–72
Dolan P (1997) Modeling valuations for EuroQol health states. Med Care 35:1095–1108
Burstrom K, Johannesson M, Diderichsen F (2001) Swedish population health-related quality of life results using the EQ-5D. Qual Life Res 10:621–635
Wackerly DD, Mendenhall W, Schaeffer RL (1996) Mathematical statistics with applications. Duxbury Press, Belmont
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 6:327–340
Neter J, Kutner MH, Nachtsheim CJ, Wasserman W (1996) Applied linear statistical models. McGraw-Hill, Chicago
Gujarati DN (2003) Basic econometrics. McGraw-Hill, New York
Johnell O, Kanis JA, Jonsson B, Oden A, Johansson H, De Laet C (2005) The burden of hospitalised fractures in Sweden. Osteoporos Int 16:222–228
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
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 22:1153–1165
Johnell O, Jonsson B, Jonsson L, Black D (2003) Cost effectiveness of alendronate (Fosamax) for the treatment of osteoporosis and prevention of fractures. Pharmacoeconomics 21:305–314
Jonsson B, Christiansen C, Johnell O, Hedbrandt J (1995) Cost-effectiveness of fracture prevention in established osteoporosis. Osteoporos Int 5:136–142
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 12:1042–1049
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 19:141–148
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 320:341–346
Brazier JE, Green C, Kanis JA (2002) A systematic review of health state utility values for osteoporosis-related conditions. Osteoporos Int 13:768–776
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 11:473–481
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
Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B (2004) Excess mortality after hospitalisation for vertebral fracture. Osteoporos Int 15:108–112
Dolan P, Torgerson D, Kakarlapudi TK (1999) Health-related quality of life of Colles’ fracture patients. Osteoporos Int 9:196–199
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 248:387–396
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 8:27–35
Ekman M, Zethraeus N, Dahlström U, Höglund C (2002) Är behandling av hjärtsvikt med betablockerare kostnadseffektiv? Läkartidningen 99
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 7:518–528
Kostnad per vårdtillfälle, vårddag och läkarbesök på sjukhus 2001. http://www.lf.se/sek/tankstation.htm, Landstingsförbundet, Stockholm
Sydöstra sjukvårdsregionen, 2004 [online]. http://www.lio.se/utm/gen1.asp?ArticleId=23077. Accessed 23 December 2004
Uppsala Akademiska Sjukhus, 2004 [online]. http://www.lul.se/svn/. Accessed 14 May 2004
Norrlands universitetssjukhus, 2004 [online]. http://www.norrlandstingen.nu/nuspri04utg2.xls. Accessed 23 December 2004
Universitetssjukhuset MAS, 2004 [online]. http://www.srvn.org/prislista.htm. Accessed 23 December 2004
Universitetssjukhuset i Lund, 2004 [online]. http://www.srvn.org/prislista.htm. Accessed 23 December 2004
Nyköping lasarett, 2004 [online]. http://www.lul.se/svn/. Accessed 14 May 2004
Mälarsjukhuset, 2004 [online]. http://www.lul.se/svn/. Accessed 14 May 2004
Huddinge Universitetssjukhus, 2004 [online]. http://www.extern.bkv.sll.se/samv.sthlm–gotland/. Accessed 10 September 2004
Karolinska Univeristetssjukhuset, 2004 [online]. http://www.extern.bkv.sll.se/samv.sthlm–gotland/. Accessed 9 September 2004
Västra Sjukvårdsregionen, 2004 [online]. http://www.vgregion.se/upload/svn%20–%20samverkansnämden/utomlanspriser_2004.pdf. Accessed 28 June 2004
Universitetssjukhuset i írebro, 2004 [online]. http://www.lul.se/svn/. Accessed 14 May 2004
Stockholms stads budgetavräkning 2003 [online]. http://www.stockholm.se/files/71600–71699/file_71645.pdf. Accessed 20 December 2004
Acknowledgments
Financial support for this study was obtained from The Alliance for Better Bone Health. We are most grateful to the research nurses who collected the data. Without your help this study could not and cannot be conducted. Thank you: Ulla-Britt Ohlsson, Anita Söderqvist, Eva Ekström, Helen Wikdahl, Susanne Thomas and Karin Önnby.
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Borgström, F., Zethraeus, N., Johnell, O. et al. Costs and quality of life associated with osteoporosis-related fractures in Sweden. Osteoporos Int 17, 637–650 (2006). https://doi.org/10.1007/s00198-005-0015-8
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DOI: https://doi.org/10.1007/s00198-005-0015-8