Institute for Physical Activity and Nutrition Research (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
Department of Medicine-Western Health, The University of Melbourne, Melbourne, VIC, Australia.
Osteoporos Int. 2022 Sep;33(9):1895-1907. doi: 10.1007/s00198-022-06460-5. Epub 2022 Jun 15.
This study identified the costs and health-related quality of life impacts of several post-fracture multidisciplinary care pathways specific to individual skeletal site (hip, distal forearm, vertebrae, humerus). These care pathways may assist healthcare providers in allocating resources for osteoporotic fractures in more effective and cost-efficient ways.
This micro-costing study was undertaken to provide the estimated healthcare costs of several fracture site-specific health service use pathways associated with different trajectories of health-related quality of life (HRQoL) 12-months post-fracture.
The study included 4126 adults aged ≥ 50 years with a fragility fracture (1657 hip, 681 vertebrae, 1354 distal forearm, 434 humerus) from the International Costs & Utilities Related to Osteoporotic fractures Study (ICUROS). ICUROS participants were asked to recall the frequency and duration (where applicable) of their health and community care service use at 4- and 12-month follow-up visits. Patient-level costs were identified and aggregated to determine the average cost of healthcare use related to the fracture in each care pathway (presented in Australian 2021 dollars). Mean cost differences were calculated and analysed using a one-way analysis of variance (ANOVA) and post hoc Bonferroni correction to determine any statistically significant differences.
The total direct cost of fractures was estimated at $89564, $38926, $18333, and $38461AUD per patient for hip, vertebral, wrist, and humeral participants, respectively. A Kruskal-Wallis test yielded a statistically significant difference in cost values between most care pathways (p < 0.001). Of the 20 care pathways, those associated with recovery of HRQoL had lower mean costs per patient across each fracture site.
This study identified the costs and HRQoL impacts of several multidisciplinary care pathways for individual fracture sites based on the health service utilization of an international cohort of older adults. These care pathways may assist healthcare providers in allocating resources for fragility fractures in more effective and cost-efficient ways.
本研究确定了几种特定于骨骼部位（髋部、远端前臂、椎体、肱骨）骨折后多学科护理途径的成本和与健康相关的生活质量影响。这些护理途径可以帮助医疗保健提供者更有效地分配资源，以治疗骨质疏松性骨折。
本微观成本研究旨在提供与骨折后 12 个月内不同健康相关生活质量（HRQoL）轨迹相关的几种特定于骨折部位的卫生服务使用途径的估计医疗保健成本。
该研究包括来自国际骨质疏松性骨折成本和效用研究（ICUROS）的 4126 名年龄≥50 岁的脆性骨折患者（1657 髋部、681 椎体、1354 远端前臂、434 肱骨）。ICUROS 参与者被要求在 4 个月和 12 个月的随访中回忆他们的健康和社区护理服务使用频率和持续时间（如适用）。确定患者层面的成本并进行汇总，以确定每个护理途径中与骨折相关的医疗保健使用的平均成本（以澳大利亚 2021 年美元表示）。使用单向方差分析（ANOVA）和事后 Bonferroni 校正计算和分析平均成本差异，以确定任何具有统计学意义的差异。
髋部、椎体、腕部和肱骨参与者的骨折总直接成本分别估计为每位患者 89564、38926、18333 和 38461 澳元。Kruskal-Wallis 检验显示大多数护理途径之间的成本值存在统计学显著差异（p<0.001）。在 20 种护理途径中，与 HRQoL 恢复相关的护理途径在每个骨折部位的每位患者的平均成本都较低。
本研究根据国际老年人群队列的卫生服务利用情况，确定了几种针对特定骨折部位的多学科护理途径的成本和对健康相关生活质量的影响。这些护理途径可以帮助医疗保健提供者更有效地分配资源，以治疗骨质疏松性骨折。
