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An economic evaluation: Simulation of the cost-effectiveness and cost-utility of universal prevention strategies against osteoporosis-related fractures.

https://arctichealth.org/en/permalink/ahliterature120571
Source
J Bone Miner Res. 2013 Feb;28(2):383-94
Publication Type
Article
Date
Feb-2013
Author
Léon Nshimyumukiza
Audrey Durand
Mathieu Gagnon
Xavier Douville
Suzanne Morin
Carmen Lindsay
Julie Duplantie
Christian Gagné
Sonia Jean
Yves Giguère
Sylvie Dodin
François Rousseau
Daniel Reinharz
Author Affiliation
Département de médecine sociale et préventive, Faculté de Médecine, Université Laval, Québec, Québec, Canada.
Source
J Bone Miner Res. 2013 Feb;28(2):383-94
Date
Feb-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Canada
Computer simulation
Cost-Benefit Analysis
Decision Support Techniques
Female
Humans
Middle Aged
Osteoporosis - complications - economics
Osteoporotic Fractures - complications - economics - prevention & control - therapy
Abstract
A patient-level Markov decision model was used to simulate a virtual cohort of 500,000 women 40 years old and over, in relation to osteoporosis-related hip, clinical vertebral, and wrist bone fractures events. Sixteen different screening options of three main scenario groups were compared: (1) the status quo (no specific national prevention program); (2) a universal primary prevention program; and (3) a universal screening and treatment program based on the 10-year absolute risk of fracture. The outcomes measured were total directs costs from the perspective of the public health care system, number of fractures, and quality-adjusted life-years (QALYs). Results show that an option consisting of a program promoting physical activity and treatment if a fracture occurs is the most cost-effective (CE) (cost/fracture averted) alternative and also the only cost saving one, especially for women 40 to 64 years old. In women who are 65 years and over, bone mineral density (BMD)-based screening and treatment based on the 10-year absolute fracture risk calculated using a Canadian Association of Radiologists and Osteoporosis Canada (CAROC) tool is the best next alternative. In terms of cost-utility (CU), results were similar. For women less than 65 years old, a program promoting physical activity emerged as cost-saving but BMD-based screening with pharmacological treatment also emerged as an interesting alternative. In conclusion, a program promoting physical activity is the most CE and CU option for women 40 to 64 years old. BMD screening and pharmacological treatment might be considered a reasonable alternative for women 65 years old and over because at a healthcare capacity of $50,000 Canadian dollars ($CAD) for each additional fracture averted or for one QALY gained its probabilities of cost-effectiveness compared to the program promoting physical activity are 63% and 75%, respectively, which could be considered socially acceptable. Consideration of the indirect costs could change these findings.
Notes
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PubMed ID
22991210 View in PubMed
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The burden of illness of osteoporosis in Canadian men.

https://arctichealth.org/en/permalink/ahliterature125686
Source
J Bone Miner Res. 2012 Aug;27(8):1830-8
Publication Type
Article
Date
Aug-2012
Author
Jean-Eric Tarride
Na Guo
Robert Hopkins
William D Leslie
Suzanne Morin
Jonathan D Adachi
Alexandra Papaioannou
Louis Bessette
Jacques P Brown
Ron Goeree
Author Affiliation
Programs for Assessment of Technology in Health (PATH) Research Institute, St Joseph's Healthcare, Hamilton, Ontario, Canada. tarride@mcmaster.ca
Source
J Bone Miner Res. 2012 Aug;27(8):1830-8
Date
Aug-2012
Language
English
Publication Type
Article
Keywords
Age Distribution
Aged
Aged, 80 and over
Canada - epidemiology
Cost of Illness
Fractures, Bone - complications - diagnosis - economics
Health Expenditures
Hospitalization - economics
Humans
Length of Stay - economics
Male
Men
Middle Aged
Osteoporosis - complications - economics - epidemiology
Abstract
There is a dearth of information about the burden of osteoporosis in Canadian men. To fill this gap, we conducted a burden of illness study aimed at estimating the economic burden attributable to osteoporosis in Canadian men aged 50 years and older. Five national data sources were used to estimate health care resource utilization and costs (in 2010 Canadian dollars) associated with osteoporosis in men. Any information gap was supplemented by using data from provincial and community sources. Direct medical costs included costs associated with hospitalizations, same day surgeries, emergency room visits, rehabilitation, chronic care, long-term care, home care, physician visits, and prescribed medications. The value of lost productivity from patients and informal caregivers was also determined to provide a societal perspective. Sensitivity analyses were conducted to evaluate the impact of key assumptions on the results. In fiscal year 2007/2008, the total economic burden of treating and rehabilitating male osteoporotic fractures was estimated at $570 million per year, where direct medical costs accounted for 86%. Acute care utilization was responsible for 70% of all direct costs. About 51% of all hospitalizations were for hip fractures and hip fractures alone accounted for 54% of the acute care spending. If a proportion of Canadian men were assumed to live in long-term care facilities due to osteoporosis, the overall annual cost of osteoporosis would increase from $570 million to $910 million. Male osteoporosis has a substantial economic burden on the Canadian society.
PubMed ID
22461152 View in PubMed
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Cost-effectiveness of a multifaceted intervention to improve quality of osteoporosis care after wrist fracture.

https://arctichealth.org/en/permalink/ahliterature140406
Source
Osteoporos Int. 2011 Jun;22(6):1799-808
Publication Type
Article
Date
Jun-2011
Author
S R Majumdar
D A Lier
B H Rowe
A S Russell
F A McAlister
W P Maksymowych
D A Hanley
D W Morrish
J A Johnson
Author Affiliation
Department of Medicine, University of Alberta, Edmonton, AB, Canada. me2.majumdar@ualberta.ca
Source
Osteoporos Int. 2011 Jun;22(6):1799-808
Date
Jun-2011
Language
English
Publication Type
Article
Keywords
Aged
Alberta
Bone Density - physiology
Cost-Benefit Analysis
Decision Support Techniques
Epidemiologic Methods
Female
Health Care Costs - statistics & numerical data
Humans
Male
Middle Aged
Models, Econometric
Osteoporosis - complications - economics - physiopathology - therapy
Osteoporotic Fractures - economics - physiopathology - prevention & control
Quality Improvement - economics - organization & administration
Quality-Adjusted Life Years
Recurrence - prevention & control
Wrist Injuries - etiology - physiopathology
Abstract
In a randomized trial, a multifaceted intervention tripled rates of osteoporosis treatment in older patients with wrist fracture. An economic analysis of the trial now demonstrates that the intervention tested "dominates" usual care: over a lifetime horizon, it reduces fracture, increases quality-adjusted life years, and saves the healthcare system money.
In a randomized trial (N = 272), we reported a multifaceted quality improvement intervention directed at older patients and their physicians could triple rates of osteoporosis treatment within 6 months of a wrist fracture when compared with usual care (22% vs 7%). Alongside the trial, we conducted an economic evaluation.
Using 1-year outcome data from our trial and micro-costing time-motion studies, we constructed a Markov decision-analytic model to determine cost-effectiveness of the intervention compared with usual care over the patients' remaining lifetime. We took the perspective of third-party healthcare payers. In the base case, costs and benefits were discounted at 3% and expressed in 2006 Canadian dollars. One-way deterministic and probabilistic sensitivity analyses were conducted.
Median age of patients was 60 years, 77% were women, and 72% had low bone mineral density (BMD). The intervention cost $12 per patient. Compared with usual care, the intervention strategy was dominant: for every 100 patients receiving the intervention, three fractures (one hip fracture) would be prevented, 1.1 quality-adjusted life year gained, and $26,800 saved by the healthcare system over their remaining lifetime. The intervention dominated usual care across numerous one-way sensitivity analyses: with respect to cost, the most influential parameter was drug price; in terms of effectiveness, the most influential parameter was rate of BMD testing. The intervention was cost saving in 80% of probabilistic model simulations.
For outpatients with wrist fractures, our multifaceted osteoporosis intervention was cost-effective. Healthcare systems implementing similar interventions should expect to save money, reduce fractures, and gain quality-adjusted life expectancy.
PubMed ID
20878389 View in PubMed
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Costs and quality of life associated with osteoporosis-related fractures in Sweden.

https://arctichealth.org/en/permalink/ahliterature171980
Source
Osteoporos Int. 2006;17(5):637-50
Publication Type
Article
Date
2006
Author
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
Author Affiliation
Medical Management Centre, Karolinska Institutet, Stockholm, Sweden. frederik.b@healtheconomics.se
Source
Osteoporos Int. 2006;17(5):637-50
Date
2006
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Costs and Cost Analysis
Female
Fractures, Bone - economics - etiology
Hip Fractures - economics - etiology
Humans
Male
Middle Aged
Osteoporosis - complications - economics
Prospective Studies
Quality of Life
Spinal Fractures - economics - etiology
Sweden
Wrist Injuries - economics - etiology
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.
PubMed ID
16283064 View in PubMed
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Economic implication of osteoporotic spine disease: cost to society.

https://arctichealth.org/en/permalink/ahliterature183588
Source
Eur Spine J. 2003 Oct;12 Suppl 2:S168-9
Publication Type
Article
Date
Oct-2003
Author
Olof Johnell
Author Affiliation
Department of Orthopaedics, Malmö University Hospital, 205 02, Malmö, Sweden. olof.johnell@orto.mas.lu.se
Source
Eur Spine J. 2003 Oct;12 Suppl 2:S168-9
Date
Oct-2003
Language
English
Publication Type
Article
Keywords
Aged
Health Care Costs
Humans
Osteoporosis - complications - economics
Spinal Fractures - economics - etiology
Spine - pathology
Sweden
United States
Abstract
The costs of vertebral fractures are less well defined than the costs of hip fractures. Large studies are urgently needed. From the data that exist, vertebral fractures have a higher cost than previously expected: for hospitalized fractures in a US study, USD 10 000 per year without rehabilitation costs, for all clinical fractures USD 2000 the first year, and in a Swedish study slightly more. These new data on the cost of vertebral fractures will have an impact on health economy calculations. In the future it may be be cost-effective only to prevent vertebral fractures.
Notes
Cites: Osteoporos Int. 2000;11(7):577-8211069191
Cites: J Bone Miner Res. 2002 Apr;17(4):716-2411918229
Cites: Osteoporos Int. 1999;10(1):66-7210501782
Cites: Osteoporos Int. 2003 Jun;14(5):383-812730750
Cites: Osteoporos Int. 2003 Jun;14(5):429-3612730759
Cites: Osteoporos Int. 2003 Jan;14(1):53-6012577185
PubMed ID
14505121 View in PubMed
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Epidemiology and socio-economic aspects of osteoporosis in Finland.

https://arctichealth.org/en/permalink/ahliterature233870
Source
Ann Chir Gynaecol. 1988;77(5-6):173-5
Publication Type
Article
Date
1988
Author
O. Simonen
Author Affiliation
National Board of Health of Finland, Helsinki.
Source
Ann Chir Gynaecol. 1988;77(5-6):173-5
Date
1988
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cohort Studies
Costs and Cost Analysis
Female
Femoral Neck Fractures - epidemiology - etiology
Finland
Humans
Male
Middle Aged
Osteoporosis - complications - economics - epidemiology
Socioeconomic Factors
Abstract
The public health problem of osteoporosis is assessed epidemiologically and economically. Osteoporosis is mainly a problem of old people. Ageing of the population will increase the number of osteoporotic fracture patients and the need of hospital and other services. It is possible to prevent osteoporosis and the goal of health planning activities should thus be directed more to the prevention of osteoporosis.
PubMed ID
3267104 View in PubMed
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Fragility fractures in Europe: burden, management and opportunities.

https://arctichealth.org/en/permalink/ahliterature306198
Source
Arch Osteoporos. 2020 04 19; 15(1):59
Publication Type
Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't
Date
04-19-2020
Author
Fredrik Borgström
Linda Karlsson
Gustav Ortsäter
Nicolas Norton
Philippe Halbout
Cyrus Cooper
Mattias Lorentzon
Eugene V McCloskey
Nicholas C Harvey
Muhamamd K Javaid
John A Kanis
Author Affiliation
Medical Management Centre, Department of Learning Informatics, Management and Ethics, Karolinska Institute, Solna, Sweden.
Source
Arch Osteoporos. 2020 04 19; 15(1):59
Date
04-19-2020
Language
English
Publication Type
Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Aged
Cost of Illness
Europe - epidemiology
Female
Healthcare Disparities - economics
Humans
Male
Middle Aged
Osteoporosis - complications - economics
Osteoporotic Fractures - economics - epidemiology - etiology
Quality-Adjusted Life Years
Retrospective Studies
Sweden - epidemiology
Abstract
This report provides an overview and a comparison of the burden and management of fragility fractures in the largest five countries of the European Union plus Sweden (EU6). In 2017, new fragility fractures in the EU6 are estimated at 2.7 million with an associated annual cost of €37.5 billion and a loss of 1.0 million quality-adjusted life years.
Osteoporosis is characterized by reduced bone mass and strength, which increases the risk of fragility fractures, which in turn, represent the main consequence of the disease. This report provides an overview and a comparison of the burden and management of fragility fractures in the largest five EU countries and Sweden (designated the EU6).
A series of metrics describing the burden and management of fragility fractures were defined by a scientific steering committee. A working group performed the data collection and analysis. Data were collected from current literature, available retrospective data and public sources. Different methods were applied (e.g. standard statistics and health economic modelling), where appropriate, to perform the analysis for each metric.
Total fragility fractures in the EU6 are estimated to increase from 2.7 million in 2017 to 3.3 million in 2030; a 23% increase. The resulting annual fracture-related costs (€37.5 billion in 2017) are expected to increase by 27%. An estimated 1.0 million quality-adjusted life years (QALYs) were lost in 2017 due to fragility fractures. The current disability-adjusted life years (DALYs) per 1000 individuals age 50 years or more were estimated at 21 years, which is higher than the estimates for stroke or chronic obstructive pulmonary disease. The treatment gap (percentage of eligible individuals not receiving treatment with osteoporosis drugs) in the EU6 is estimated to be 73% for women and 63% for men; an increase of 17% since 2010. If all patients who fracture in the EU6 were enrolled into fracture liaison services, at least 19,000 fractures every year might be avoided.
Fracture-related burden is expected to increase over the coming decades. Given the substantial treatment gap and proven cost-effectiveness of fracture prevention schemes such as fracture liaison services, urgent action is needed to ensure that all individuals at high risk of fragility fracture are appropriately assessed and treated.
PubMed ID
32306163 View in PubMed
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Long-term cost and effect on quality of life of osteoporosis-related fractures in Sweden.

https://arctichealth.org/en/permalink/ahliterature86590
Source
Acta Orthop. 2008 Apr;79(2):269-80
Publication Type
Article
Date
Apr-2008
Author
Ström Oskar
Borgstrom Fredrik
Zethraeus Niklas
Johnell Olof
Lidgren Lars
Ponzer Sari
Svensson Olle
Abdon Peter
Ornstein Ewald
Ceder Leif
Thorngren Karl Goran
Sernbo Ingemar
Jonsson Bengt
Author Affiliation
Innovus, Stockholm, Sweden. oskar.s@healtheconomics.se
Source
Acta Orthop. 2008 Apr;79(2):269-80
Date
Apr-2008
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cost of Illness
Female
Fractures, Spontaneous - economics - etiology - psychology
Health Care Costs
Hip Fractures - economics - etiology - psychology
Humans
Male
Middle Aged
Osteoporosis - complications - economics - psychology
Prognosis
Prospective Studies
Quality of Life
Questionnaires
Spinal Fractures - economics - etiology - psychology
Sweden
Time Factors
Wrist Injuries - economics - etiology - psychology
Abstract
BACKGROUND AND PURPOSE: Few economic or quality-of-life studies have investigated the long-term consequences of fragility fractures. This prospective observational data collection study assessed the cost and quality of life related to hip, vertebral, and wrist fracture 13-18 months after the fracture, based on 684 patients surviving 18 months after fracture. PATIENTS AND METHODS: Data regarding resource use and quality of life related to fractures was collected using questionnaires at 7 research centers in Sweden. Information was collected using patient records, register sources, and by asking the patient. Quality of life was estimated using the EQ-5D questionnaire. Direct and indirect costs were estimated from a societal standpoint. RESULTS: The mean fracture-related cost 13-18 months after a hip, vertebral, or wrist fracture were estimated to be euro2,422, euro3,628, and euro316, respectively. Between 12 and 18 months after hip, vertebral, and wrist fracture, utility increased by 0.03, 0.05, and 0.02, respectively. Compared to prefracture levels, the mean loss in quality of life between 13 and 18 months after fracture was estimated to be 0.05, 0.11, and 0.005 for hip, vertebral, and wrist fracture. INTERPRETATION: The sample of vertebral fracture patients was fairly small and included a high proportion of fractures leading to hospitalization, but the results indicate higher long-term costs and greater loss in quality of life related to vertebral fracture than previously believed.
PubMed ID
18484255 View in PubMed
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One year outcomes and costs following a vertebral fracture.

https://arctichealth.org/en/permalink/ahliterature71014
Source
Osteoporos Int. 2005 Jan;16(1):78-85
Publication Type
Article
Date
Jan-2005
Author
R. Lindsay
R T Burge
D M Strauss
Author Affiliation
Helen Hayes Hospital, West Haverstraw, NY, USA.
Source
Osteoporos Int. 2005 Jan;16(1):78-85
Date
Jan-2005
Language
English
Publication Type
Article
Keywords
Aged
Clinical Trials, Phase III
Costs and Cost Analysis - methods
Decision Trees
Female
Forearm Injuries - economics - etiology
Hip Fractures - economics - etiology
Humans
Osteoporosis - complications - economics
Outcome Assessment (Health Care) - economics - methods
Probability
Recurrence
Research Support, Non-U.S. Gov't
Spinal Fractures - economics - etiology
Wrist Injuries - economics - etiology
Abstract
Vertebral fractures are believed to be important predictors for future vertebral and other fractures, leading to at least a 4- to 5-fold increase in the risk of subsequent fractures. However, little is known about their associated near-term costs. The purpose of this study was to quantify the subsequent fracture and cost outcomes emanating from patients with an incident vertebral fracture. A probabilistic decision analysis model was developed to estimate the expected cost of all subsequent fractures. We ran Kaplan-Meier time-to-event models on placebo patients in risedronate's pivotal phase III clinical trial data to determine the cumulative incidence or probabilities of all fractures within one year of an incident vertebral fracture. Unit costs for health care payers in the USA and Sweden for vertebral, hip, other, and forearm/wrist fractures were multiplied by fracture probabilities to generate the expected costs of new fractures within one year of incident vertebral fractures. Our analysis found that that 26.1% of vertebral fracture patients with a mean age of 74 years refractured within 1 year (vertebral 17.4%; hip 3.6%; "other" 3.5%; forearm/wrist 1.6%). The calculated medical costs for those patients who refracture within 1 year was $5906 and 3670 euros for the USA and Sweden, respectively, while the weighted average cost across all patients (refracture and non-fracture) within a year of their incident fracture was $1541 (USA) and 958 euros (Sweden). These results suggest that therapies with proven, rapid efficacy may offer important economic value to healthcare payers, providers and patients.
PubMed ID
15167988 View in PubMed
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[Osteoporosis concerns everyone. A threat against public health which can be averted, according to the SBU-report].

https://arctichealth.org/en/permalink/ahliterature182627
Source
Lakartidningen. 2003 Nov 6;100(45):3574-5
Publication Type
Article
Date
Nov-6-2003
Author
Mats Palmér
Author Affiliation
Endokrint centrum, S:t Görans sjukhus AB, Stockholm. Mats.Palmer@stgoran.se
Source
Lakartidningen. 2003 Nov 6;100(45):3574-5
Date
Nov-6-2003
Language
Swedish
Publication Type
Article
Keywords
Cost of Illness
Health Care Costs
Humans
Osteoporosis - complications - economics - epidemiology - prevention & control
Public Health
Sweden - epidemiology
PubMed ID
14650030 View in PubMed
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10 records – page 1 of 1.