Heron Evidence Development Ltd, Luton, UK.
Pharmacoeconomics. 2012 Feb 1;30(2):147-70. doi: 10.2165/11596880-000000000-00000.
Osteoporotic fractures are costly in terms of both the dollar amount and healthcare utilization. The objective of this review was to systematically synthesize published evidence regarding direct costs associated with the treatment of osteoporosis-related fractures in the U.S. We conducted a systematic literature review of published studies that used claims databases and economic studies reporting costs associated with osteoporosis-related fractures in the U.S. Studies published between 1990 and 2011 were systematically searched in PubMed (primary source), Ovid HealthSTAR, EMBASE and the websites of large agencies. Data concerning study design, patient population and cost components assessed were extracted with qualitative assessment of study methods, limitations and conclusions. Cost assessment included direct medical and hospitalization (inpatient) costs. The cost differences by age and gender were examined. Of the 33 included studies, 26 reported an estimated total medical cost and hospital resource use associated with osteoporotic fractures. These studies indicated that, in the year following a fracture, medical and hospitalization costs were 1.6-6.2 higher than pre-fracture costs and 2.2-3.5 times higher than those for matched controls. Analysis of the hospitalization costs by osteoporotic fracture type resulted in hip fractures identified as the most expensive fracture type (unit cost range $US 8358-32195), while wrist and forearm fractures were the least expensive (unit cost range $US 1885-12136). Although incremental fracture costs were generally lower in the elderly than in the younger population, total costs were highest for the older (≥65 years of age) population. Total healthcare costs for fractures were highest for the older female population, but unit fracture costs in women were not consistently found to be higher than for men. The qualitative assessment of the included studies demonstrated that the design and reporting of individual studies were of good quality. However, the findings of this review and comparisons across studies were limited by differences in methodologies used by the different studies to derive costs, the populations included in the studies used and the fracture assessment. Despite the variability in estimates, the literature indicates that osteoporosis-related fractures are associated with high total medical and hospitalization costs in the U.S. The variability in the cost estimates highlights the importance of comparing the methodologies and the types of costs used when choosing an appropriate unit cost for economic modelling.
骨质疏松性骨折在经济和医疗资源利用方面都代价高昂。本综述的目的是系统地综合已发表的证据，评估美国与骨质疏松性骨折治疗相关的直接成本。我们对已发表的使用索赔数据库和经济研究报告美国与骨质疏松性骨折相关成本的研究进行了系统文献检索。在 PubMed（主要来源）、Ovid HealthSTAR、EMBASE 和大型机构网站上对 1990 年至 2011 年期间发表的研究进行了系统检索。提取了研究设计、患者人群和评估的成本构成数据，并对研究方法、局限性和结论进行了定性评估。成本评估包括直接医疗和住院（住院）成本。还检查了按年龄和性别划分的成本差异。在纳入的 33 项研究中，有 26 项报告了与骨质疏松性骨折相关的估计总医疗成本和医院资源使用情况。这些研究表明，在骨折后一年，医疗和住院费用比骨折前高 1.6-6.2 倍，比匹配对照组高 2.2-3.5 倍。对不同类型骨质疏松性骨折的住院费用进行分析后发现，髋部骨折的费用最高（单位成本范围为 8358-32195 美元），而腕部和前臂骨折的费用最低（单位成本范围为 1885-12136 美元）。虽然老年患者的增量骨折成本一般低于年轻患者，但老年患者的总费用最高。老年女性的骨折总医疗费用最高，但女性的单位骨折成本并不总是高于男性。对纳入研究的定性评估表明，个体研究的设计和报告质量良好。然而，由于不同研究采用的成本推导方法、研究纳入的人群以及骨折评估方法的不同，本综述的研究结果和跨研究比较受到限制。尽管估计值存在差异，但文献表明，美国与骨质疏松性骨折相关的医疗费用和住院费用很高。成本估计值的差异突出表明，在选择经济模型的适当单位成本时，比较方法和使用的成本类型非常重要。
