A model of osteoporosis impact in Switzerland 2000–2020

Abstract

The aim of our study was to develop a modeling framework suitable to quantify the incidence, absolute number and economic impact of osteoporosis-attributable hip, vertebral and distal forearm fractures, with a particular focus on change over time, and with application to the situation in Switzerland from 2000 to 2020. A Markov process model was developed and analyzed by Monte Carlo simulation. A demographic scenario provided by the Swiss Federal Statistical Office and various Swiss and international data sources were used as model inputs. Demographic and epidemiologic input parameters were reproduced correctly, confirming the internal validity of the model. The proportion of the Swiss population aged 50 years or over will rise from 33.3% in 2000 to 41.3% in 2020. At the total population level, osteoporosis-attributable incidence will rise from 1.16 to 1.54 per 1,000 person-years in the case of hip fracture, from 3.28 to 4.18 per 1,000 person-years in the case of radiographic vertebral fracture, and from 0.59 to 0.70 per 1,000 person-years in the case of distal forearm fracture. Osteoporosis-attributable hip fracture numbers will rise from 8,375 to 11,353, vertebral fracture numbers will rise from 23,584 to 30,883, and distal forearm fracture numbers will rise from 4,209 to 5,186. Population-level osteoporosis-related direct medical inpatient costs per year will rise from 713.4 million Swiss francs (CHF) to CHF946.2 million. These figures correspond to 1.6% and 2.2% of Swiss health care expenditures in 2000. The modeling framework described can be applied to a wide variety of settings. It can be used to assess the impact of new prevention, diagnostic and treatment strategies. In Switzerland incidences of osteoporotic hip, vertebral and distal forearm fracture will rise by 33%, 27%, and 19%, respectively, between 2000 and 2020, if current prevention and treatment patterns are maintained. Corresponding absolute fracture numbers will rise by 36%, 31%, and 23%. Related direct medical inpatient costs are predicted to increase by 33%; however, this estimate is subject to uncertainty due to limited availability of input data.

The health and economic consequences of osteopenia- and osteoporosis-attributable hip fractures in Germany: estimation for 2002 and projection until 2050

“…Whilst the values of Burge et al [29], Schwenkglenks et al [31] and Sanders et al [4] came relatively close to the values we determined, the results of Borgström et al [30] were considerably below the cost increase we determined up to 2050. But these comparisons must be handled with care, since differing population mixtures and differing demographic prognoses limit international comparability.…”

Bone Mineral Density is Not Correlated with One-Year Functional Outcome in Distal Radial Fractures: A Preliminary Study

“…Recent investigation has revealed that bone and fall-related risk factors might be of greater importance in the etiology of fractures than was assumed previously [3]. Because of the growing proportion of elderly people in Western societies, the number of these fractures can be expected to increase further in the coming years [4][5][6][7]. Adults who suffer fractures of the distal radius are at increased risk of further osteoporosis-related fractures and represent a high-risk group in whom therapy is needed to reduce the risk [7].…”

Comparative trends in hospitalizations for osteoporotic fractures and other frequent diseases between 2000 and 2008

“…The total direct medical cost of all hospitalized osteoporotic fractures can be extrapolated to CHF 524 mio, to which the inpatient rehabilitation and nursing home costs should be added. These represent approximately 50% of the total cost of the inpatient management of osteoporotic fractures, as already published earlier by our group [38], so that the total cost of treating hospitalized osteoporotic fractures in Switzerland exceeded CHF 1 billion in 2008. Cost estimates calculated in the present analysis are based on the nationwide average real cost per day of hospitalization and not on discipline-specific costs or Diagnosis Related Groups (DRGs).…”