Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada.
Osteoporos Int. 2013 Feb;24(2):659-69. doi: 10.1007/s00198-012-2034-6. Epub 2012 Jun 27.
Using a matched cohort design, we estimated the mean direct attributable cost in the first year after hip fracture in Ontario to be $36,929 among women and $39,479 among men. These estimates translate into an annual $282 million in direct attributable health-care costs in Ontario and $1.1 billion in Canada.
Osteoporosis is a major public health concern that results in substantial fracture-related morbidity and mortality. It is well established that hip fractures are the most devastating consequence of osteoporosis, yet the health-care costs attributed to hip fractures in Canada have not been thoroughly evaluated.
We determined the 1- and 2-year direct attributable costs and cost drivers associated with hip fractures among seniors in comparison to a matched non-hip fracture cohort using health-care administrative data from Ontario (2004-2008). Entry into long-term care and deaths attributable to hip fracture were also determined.
We successfully matched 22,418 female (mean age = 83.3 years) and 7,611 male (mean age = 81.3 years) hip fracture patients. The mean attributable cost in the first year after fracture was $36,929 (95 % CI $36,380-37,466) among women and $39,479 (95 % CI $38,311-$40,677) among men. These estimates translate into an annual $282 million in direct attributable health-care costs in Ontario and $1.1 billion in Canada. Primary cost drivers were acute and post-acute institutional care. Approximately 24 % of women and 19 % of men living in the community at the time of fracture entered a long-term care facility, and 22 % of women and 33 % of men died within the first year following hip fracture. Attributable costs remained elevated into the second year ($9,017 among women, $10,347 among men) for patients who survived the first year.
We identified significant health-care costs, entry into long-term care, and mortality attributed to hip fractures. Results may inform health economic analyses and policy decision-making in Canada.
采用匹配队列设计，我们估计安大略省髋部骨折后第一年女性的直接归因平均费用为 36929 加元，男性为 39479 加元。这些估计表明安大略省直接归因于医疗保健的年度费用为 2.82 亿加元，加拿大为 11 亿加元。
骨质疏松症是一个主要的公共卫生问题，导致大量与骨折相关的发病率和死亡率。髋部骨折是骨质疏松症最具破坏性的后果，这一点已得到充分证实，然而，加拿大髋部骨折的医疗保健费用尚未得到彻底评估。
我们使用安大略省（2004-2008 年）的医疗保健管理数据，比较了老年人髋部骨折与匹配的非髋部骨折队列，确定了 1 年和 2 年的直接归因费用以及与髋部骨折相关的成本驱动因素。还确定了因髋部骨折进入长期护理和死亡的情况。
我们成功匹配了 22418 名女性（平均年龄 83.3 岁）和 7611 名男性（平均年龄 81.3 岁）髋部骨折患者。女性骨折后第一年的平均归因费用为 36929 加元（95%置信区间 36380-37466），男性为 39479 加元（95%置信区间 38311-40677）。这些估计表明安大略省每年有 2.82 亿加元的直接归因于医疗保健的费用，加拿大有 11 亿加元。主要成本驱动因素是急性和后期机构护理。大约 24%的女性和 19%的男性在骨折时居住在社区，进入长期护理机构，22%的女性和 33%的男性在髋部骨折后的第一年死亡。在第一年存活下来的患者中，第二年（女性 9017 加元，男性 10347 加元）的归因费用仍然居高不下。
我们确定了与髋部骨折相关的大量医疗保健费用、进入长期护理和死亡。结果可能为加拿大的健康经济分析和政策决策提供信息。
