Orsini Lucinda Strycker, Rousculp Matthew D, Long Stacey R, Wang Shaohung
Outcomes Research & Econometrics, Medstat, 125 Cambridge Park Drive, Cambridge, MA 02140, USA.
Osteoporos Int. 2005 Apr;16(4):359-71. doi: 10.1007/s00198-004-1694-2. Epub 2004 Sep 1.
More than 1.5 million fractures occur due to osteoporosis each year. This study examines the annual health care utilization and associated expenditures of osteoporotic patients who sustain a new fragility fracture and of those without a new fracture.
The study sample from commercial claims databases consisted of patients enrolled in US plans between January 1, 1997, and December 31, 2001. Patients with both an osteoporosis diagnosis and a related fracture were classified as "osteoporosis with concurrent fracture"; all other osteoporosis patients were classified as "osteoporosis without concurrent fracture." Annual utilization and expenditures for the concurrent-fracture cohort were compared with those without concurrent fracture, as well as with a group of patients without osteoporosis (controls) that was matched to the concurrent-fracture cohort based on age, gender, US region, health plan type, and length of enrollment. Exponential conditional mean models were used to compute regression-adjusted total expenditures across the groups. The differences in adjusted expenditures were used to generate the economic burden-of-illness estimates.
Osteoporosis patients with concurrent fracture incurred more than twice the overall health care expenditures in the study period, compared with those without fracture (US $15,942 vs $6,476), and nearly three times those of the control group (US $15,942 vs $4,658). Approximately 25% of the overall health care expenditures (US $4,014 of $15,942) for the concurrent-fracture group were osteoporosis-related expenditures, leading to the conclusion that comorbid conditions in osteoporosis patients with concurrent fracture contribute significantly to overall health care costs. Some of these comorbidity-related costs were likely due to pain-related disorders, which occurred significantly more frequently in the concurrent-fracture cohort than in the other groups.
Osteoporosis-related expenditures, particularly those related to fracture, were substantial. However, non-osteoporosis-related expenditures to treat comorbid conditions constituted 75% of the overall health care costs in the year after an osteoporosis-related fracture, which warrants further investigation.
每年因骨质疏松症导致的骨折超过150万例。本研究调查了发生新发脆性骨折的骨质疏松症患者和未发生新发骨折的骨质疏松症患者的年度医疗保健利用情况及相关支出。
研究样本来自商业理赔数据库，由1997年1月1日至2001年12月31日期间参加美国医保计划的患者组成。既有骨质疏松症诊断又有相关骨折的患者被归类为“伴有并发骨折的骨质疏松症”；所有其他骨质疏松症患者被归类为“无并发骨折的骨质疏松症 ”。将并发骨折队列的年度利用情况和支出与无并发骨折的患者以及一组基于年龄、性别、美国地区、医保计划类型和参保时长与并发骨折队列匹配的无骨质疏松症患者（对照组）进行比较。使用指数条件均值模型计算各组经回归调整后的总支出。调整后支出的差异用于生成疾病经济负担估计值。
与未发生骨折的患者相比，伴有并发骨折的骨质疏松症患者在研究期间的总体医疗保健支出高出两倍多（15,942美元对6,476美元），几乎是对照组的三倍（15,942美元对4,658美元）。并发骨折组总体医疗保健支出的约25%（15,942美元中的4,014美元）是与骨质疏松症相关的支出，由此得出结论，伴有并发骨折的骨质疏松症患者的合并症对总体医疗保健成本有重大影响。其中一些与合并症相关的成本可能归因于疼痛相关疾病，并发骨折队列中此类疾病的发生频率明显高于其他组。
与骨质疏松症相关的支出，尤其是与骨折相关的支出数额巨大。然而，治疗合并症的非骨质疏松症相关支出占骨质疏松症相关骨折后一年总体医疗保健成本的75%，这值得进一步研究。
