Weycker Derek, Li Xiaoyan, Barron Rich, Bornheimer Rebecca, Chandler David
Policy Analysis Inc. (PAI), Brookline, MA, United States.
Amgen Inc., Thousand Oaks, CA, United States.
Bone Rep. 2016 Jul 30;5:186-191. doi: 10.1016/j.bonr.2016.07.005. eCollection 2016 Dec.
Osteoporotic fractures frequently require inpatient care, and are associated with elevated risks of morbidity, mortality, and re-hospitalization. A comprehensive evaluation of healthcare costs, resource utilization, and outcomes associated with osteoporosis (OP)-related fractures treated in US hospitals was undertaken.
A retrospective analysis using the Premier Perspective Database (2010 - 2013) was conducted. Study population comprised patients aged ≥ 50 years hospitalized with a principal diagnosis of a closed or pathologic fracture commonly associated with OP; the first qualifying hospitalization was designated the "index admission". Patients with evidence of major trauma, malignancy, or other non-OP conditions that may lead to pathologic fracture during the index admission were excluded. Study measures included healthcare costs (in 2013 USD), length of stay (LOS), intensive care unit (ICU) use, and mortality during the index admission, as well as 60-day fracture-related readmission.
A total of 268,477 patients were admitted to hospital (n = 548 hospitals) with a principal diagnosis of an OP-related fracture; mean (SD) age was 78 (11) years, 75% were female, 69% had ≥ 2 comorbidities, and 82% of patients had a diagnostic code for accidental fall. Among all OP-related fracture admissions, mean (95% CI) hospital cost was $12,839 (12,784-12,893) and LOS was 5.1 (5.1-5.1) days; during the admission, ICU use was 7.4% (7.3-7.5) and mortality was 1.5% (1.5-1.6), and during the 60-day post-discharge period, fracture-related readmission was 2.3% (2.2-2.4).
Hospital costs associated with the acute treatment of OP-related fractures are substantial, especially among patients with fractures of the hip, femur, and spine. Among patients with vertebral fractures-the second most common reason for admission-mortality and ICU use were notably high, and costs and LOS were higher than among those with non-vertebral fractures (excluding hip). Interventions that are effective in reducing fracture risk have the potential to yield substantial cost savings.
骨质疏松性骨折常常需要住院治疗，且与发病率、死亡率及再次住院风险升高相关。我们对美国医院治疗的与骨质疏松症（OP）相关骨折的医疗费用、资源利用及预后进行了全面评估。
利用Premier Perspective数据库（2010 - 2013年）进行回顾性分析。研究人群包括年龄≥50岁、因主要诊断为与OP常见相关的闭合性或病理性骨折而住院的患者；首次符合条件的住院被指定为“索引入院”。排除在索引入院期间有重大创伤、恶性肿瘤或其他可能导致病理性骨折的非OP疾病证据的患者。研究指标包括医疗费用（以2013年美元计）、住院时间（LOS）、重症监护病房（ICU）使用情况、索引入院期间的死亡率以及60天内与骨折相关的再入院情况。
共有268,477例患者因主要诊断为与OP相关骨折而入院（n = 548家医院）；平均（标准差）年龄为78（11）岁，75%为女性，69%有≥2种合并症，82%的患者有意外跌倒的诊断代码。在所有与OP相关的骨折入院病例中，平均（95%置信区间）住院费用为12,839美元（12,784 - 12,893美元），住院时间为5.1（5.1 - 5.1）天；入院期间，ICU使用率为7.4%（7.3 - 7.5%），死亡率为1.5%（1.5 - 1.6%），出院后60天内，与骨折相关的再入院率为2.3%（2.2 - 2.4%）。
与OP相关骨折的急性治疗相关的住院费用很高，尤其是在髋部、股骨和脊柱骨折患者中。在因椎体骨折入院的患者中（第二常见的入院原因），死亡率和ICU使用率显著较高，费用和住院时间高于非椎体骨折（不包括髋部）患者。有效降低骨折风险的干预措施有可能大幅节省成本。
