Radius Health, Inc, 550 E Swedesford Rd, Ste 370, Wayne, PA 19087. Email:
Am J Manag Care. 2020 May 1;26(5):e142-e149. doi: 10.37765/ajmc.2020.43156.
To examine healthcare resource utilization (HRU) and costs in a population of managed care enrollees who experienced an osteoporotic fracture.
Retrospective cohort study using the Optum Research Database (January 2007 to May 2017).
All-cause and osteoporosis-related HRU and costs were analyzed in patients 50 years and older with a qualifying index fracture and continuous enrollment with medical and pharmacy benefits for 12 months preindex (baseline period).
Of 1,841,263 patients with fractures during the identification period, 302,772 met eligibility criteria. Two-thirds (66.6%) were 65 years and older, 71.6% were women, and 41.2% were commercial (not Medicare Advantage) enrollees. The most common fracture sites were spine (21.9%), radius/ulna (19.5%), and hip (13.7%). Mean (SD) total all-cause healthcare cost was $34,855 ($56,094), with most paid by health plans ($31,863 [$55,025]) versus patients ($2992 [$2935]). Most healthcare costs were for medical ($31,766 [$54,943]) versus pharmacy ($3089 [$6799]) services. Approximately 75% of patients received rehabilitation services (mean [SD] cost = $18,025 [$41,318]). Diagnosis of index fracture during an inpatient stay versus an outpatient visit (cost ratio, 2.16; 95% CI, 2.13-2.19) and fractures at multiple sites (cost ratio, 1.23; 95% CI, 1.21-1.26) were the leading predictors of cost. Kaplan-Meier estimated cumulative second-fracture rates were 6.6% at 1 year, 12.3% at 2 years, 16.9% at 3 years, and 20.9% at 4 years after index fracture.
These findings suggest a significant economic burden associated with fractures, including a high total all-cause cost of care. Early identification and treatment of patients at high risk of fractures are of paramount importance to reduce fracture risk and associated healthcare costs.
考察经历骨质疏松性骨折的管理式医疗参保者的医疗资源利用（HRU）和成本。
利用 Optum Research Database（2007 年 1 月至 2017 年 5 月）进行回顾性队列研究。
纳入索引骨折前 12 个月（基线期）具有合格索引骨折且连续参加医疗和药物福利的年龄 50 岁及以上的所有患者，分析全因和骨质疏松相关的 HRU 和成本。
在确定期间有 1841263 名患者发生骨折，其中 302772 名符合入选标准。三分之二（66.6%）为 65 岁及以上患者，71.6%为女性，41.2%为商业（非医疗保险优势计划）参保者。最常见的骨折部位为脊柱（21.9%）、桡骨/尺骨（19.5%）和髋部（13.7%）。全因总医疗费用的平均（标准差）为 34855 美元（56094 美元），大部分由健康计划支付（31863 美元[55025 美元]），而非患者（2992 美元[2935 美元]）。大部分医疗费用用于医疗（31766 美元[54943 美元]）而非药物（3089 美元[6799 美元]）服务。约 75%的患者接受康复服务（平均[标准差]费用=18025 美元[41318 美元]）。与门诊就诊相比，索引骨折在住院期间诊断（成本比，2.16；95%置信区间，2.13-2.19）和多处骨折（成本比，1.23；95%置信区间，1.21-1.26）是成本的主要预测因素。Kaplan-Meier 估计索引骨折后 1 年、2 年、3 年和 4 年的累积二次骨折发生率分别为 6.6%、12.3%、16.9%和 20.9%。
这些发现表明骨折与巨大的经济负担相关，包括护理的全因总成本较高。早期识别和治疗骨折风险较高的患者对于降低骨折风险和相关医疗成本至关重要。
