A micro-costing analysis of post-fracture care pathways: results from the International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS)

Abstract

Summary This study identified the costs and health-related quality of life impacts of several post-fracture multidisciplinary care pathways specific to individual skeletal site (hip, distal forearm, vertebrae, humerus). These care pathways may assist healthcare providers in allocating resources for osteoporotic fractures in more effective and cost-efficient ways. Introduction This micro-costing study was undertaken to provide the estimated healthcare costs of several fracture site-specific health service use pathways associated with different trajectories of health-related quality of life (HRQoL) 12-months post-fracture. Methods The study included 4126 adults aged ≥ 50 years with a fragility fracture (1657 hip, 681 vertebrae, 1354 distal forearm, 434 humerus) from the International Costs & Utilities Related to Osteoporotic fractures Study (ICUROS). ICUROS participants were asked to recall the frequency and duration (where applicable) of their health and community care service use at 4- and 12-month follow-up visits. Patient-level costs were identified and aggregated to determine the average cost of healthcare use related to the fracture in each care pathway (presented in Australian 2021 dollars). Mean cost differences were calculated and analysed using a one-way analysis of variance (ANOVA) and post hoc Bonferroni correction to determine any statistically significant differences. Results The total direct cost of fractures was estimated at $89564, $38926, $18333, and $38461AUD per patient for hip, vertebral, wrist, and humeral participants, respectively. A Kruskal–Wallis test yielded a statistically significant difference in cost values between most care pathways ( p < 0.001). Of the 20 care pathways, those associated with recovery of HRQoL had lower mean costs per patient across each fracture site. Conclusions This study identified the costs and HRQoL impacts of several multidisciplinary care pathways for individual fracture sites based on the health service utilization of an international cohort of older adults. These care pathways may assist healthcare providers in allocating resources for fragility fractures in more effective and cost-efficient ways. Supplementary Information The online version contains supplementary material available at 10.1007/s00198-022-06460-5.

The healthcare system costs of hip fracture care in South Africa

“…In HICs, the same systematic review and meta-regression analysis reported the total health and social care costs in the 12 months following HF to be U$50,540 (95% CI; US$36,372-64,707), adjusted for inflation to 2021 prices. More recently, Talevski et al [30] reported a mean cost per patient in class 6 HF care pathway (the model we considered to have close similarities to HF care as provided in KZN public hospitals) of $48,999 (95% CI; 39,704-58,294) Australian Dollars [approximately US$30,387 (95% CI; 24,622-36,151)]. Healthcare resource utilization and costs following fractures reflect the pathways of care.…”

The association of smoking on the increased risk of osteoporotic fracture: Results from a cross-sectional study and two-sample Mendelian randomization

“…Previous studies have mostly been concerned and reported that smoking increases the risk of hip fracture 11 , 12 . However, the osteoporosis questionnaires in NHANES focus not only on hip fractures but also on wrist and spine fractures, which are common complications of osteoporosis 22 , 23 . In our current study, we performed a comprehensive study of smoking and osteoporotic fractures of the hip, wrist, and spine using the NHANES database, indicating that smoking raised the risk of these types of fractures.…”

Cost-Effectiveness of Sequential Abaloparatide/Alendronate in Men at High Risk of Fractures in the United States

“…In contrast with most previous economic evaluations that estimated the long-term costs of hip fracture based on admission rates to nursing homes following the fracture, this study used yearly incremental costs of hip, vertebral, and NHNV during a 5-year post-fracture follow-up period, according to the same study of Tran et al [ 15 ]. As hip fractures are associated with long-term admission to nursing home and costs [ 30 ], the incremental cost of hip fractures in year 5 from Tran et al was maintained for a lifetime. No cost after the 5-year period was conservatively assumed for vertebral and NHNV fractures (except in a sensitivity analysis).…”