Ng Charmaine Shuyu, Lau Tang Ching, Ko Yu
Faculty of Science, Department of Pharmacy, National University of Singapore, Singapore.
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of University Medicine Cluster, National University Health System, Singapore.
Value Health Reg Issues. 2017 May;12:27-35. doi: 10.1016/j.vhri.2016.12.002. Epub 2017 Apr 26.
To estimate the 3-month direct and indirect costs associated with osteoporotic fractures from both the hospital's and patient's perspectives in Singapore and to compare the cost between acute and prevalent osteoporotic fractures.
Resource use and expenditure data were collected using interviewer-administered questionnaires at baseline and at a 3-month follow-up between July 2013 and January 2014. Estimated osteoporotic fracture-related costs included hospitalizations, accident and emergency room visits, outpatient physician visits, laboratory tests, medications, transportation, health care and community services, special equipment and home/car modifications, and productivity loss.
A total of 67 patients agreed to participate, giving a response rate of 64.4%. The mean (median) 3-month direct medical cost from the hospital's perspective was found to be SGD 3,886.90 (SGD 413.10), of which 74.2% was accounted for by inpatient services, 25.2% by outpatient services, and 0.6% by accident and emergency services. Moreover, considerable variation (SD = SGD 2,615.40) was observed in the costs of outpatient rehabilitation services. Findings were similar when the patient's perspective was taken. The total costs, with both direct and indirect costs included, were SGD 11,438.70 (acute) and SGD 1,015.40 (prevalent), of which 34.7% and 8.0%, respectively, were accounted for by inpatient services.
Hospitalization was associated with the highest cost borne by both the hospital and the patient, and informal care dominated indirect costs. Better knowledge of the financial consequences of fragility fractures could enable proactive and preventive measures to be undertaken, especially at sites of care with high cost drivers.
从新加坡医院和患者的角度估算与骨质疏松性骨折相关的3个月直接和间接成本，并比较急性和陈旧性骨质疏松性骨折之间的成本。
在2013年7月至2014年1月期间，通过访员管理的问卷在基线和3个月随访时收集资源使用和支出数据。估计的骨质疏松性骨折相关成本包括住院治疗、急诊室就诊、门诊医生就诊、实验室检查、药物治疗、交通、医疗保健和社区服务、特殊设备以及家庭/汽车改造，以及生产力损失。
共有67名患者同意参与，应答率为64.4%。从医院角度来看，3个月的平均（中位数）直接医疗成本为3886.90新元（413.10新元），其中74.2%由住院服务产生，25.2%由门诊服务产生，0.6%由急诊服务产生。此外，门诊康复服务成本存在相当大的差异（标准差=2615.40新元）。从患者角度来看，结果相似。包括直接和间接成本在内的总成本分别为11438.70新元（急性）和1015.40新元（陈旧性），其中住院服务分别占34.7%和8.0%。
住院治疗在医院和患者承担的成本中最高，非正式护理在间接成本中占主导地位。更好地了解脆性骨折的财务后果可以采取积极的预防措施，特别是在高成本驱动因素的护理场所。
