Randell A, Sambrook P N, Nguyen T V, Lapsley H, Jones G, Kelly P J, Eisman J A
Bone and Mineral Research Division, St. Vincent's Hospital, University of New South Wales, Sydney, Australia.
Osteoporos Int. 1995;5(6):427-32. doi: 10.1007/BF01626603.
Osteoporosis is an increasing health care problem in all aging populations, but overall direct costs associated with the total fracture burden of osteoporosis remain uncertain. We have examined direct costs associated with 151 osteoporotic fractures occurring between 1989 and 1992 in a large cohort of elderly men and women followed prospectively as part of the Dubbo Osteoporosis Epidemiology Study. The median cost of hospital treated fractures was $A10,511 per fracture and for fractures treated on an outpatient basis $A455 in 1992 Australian dollars. Femoral neck fractures were the most expensive fractures ($15,984 median cost). There was no significant difference in costs between men and women for either hospital- or outpatient-treated fractures. Rehabilitation hospital costs comprised the largest proportion of costs (49%) for hospital-treated fractures. Community services comprised the major cost (40%) of outpatient-treated fractures. Univariate predictors of costs were quadriceps strength and bone density, although multivariate analysis showed quadriceps strength to be the best overall predictor of costs. The predicted annual treatment costs in Australia for atraumatic fractures occurring in subjects > or = 60 years was $A779 million or approximately $A44 million per million of population per annum. Estimated total osteoporotic fracture-related costs for the Australian population were much higher than previously reported. The majority of direct costs (95%) were incurred by hospitalized patients and related to hospital and rehabilitation costs. Extrapolation of these data suggests that the direct costs for hip fracture alone will increase approximately twofold in most Western countries by 2025. Improving the cost-effectiveness of treating osteoporotic fractures should involve reduced hospitalization and/or greater efficiency in community rehabilitation services. The costs of various approaches to osteoporosis prevention must be placed into the context of these direct costs and prevention should target men as well as women.
骨质疏松症在所有老龄化人群中都是一个日益严重的医疗保健问题，但与骨质疏松症骨折总负担相关的总体直接成本仍不明确。作为达博骨质疏松症流行病学研究的一部分，我们对一大群老年男性和女性进行了前瞻性跟踪调查，研究了1989年至1992年间发生的151例骨质疏松性骨折的直接成本。1992年，经医院治疗的骨折的中位数成本为每例骨折10,511澳元，门诊治疗的骨折为455澳元（均为澳元）。股骨颈骨折是最昂贵的骨折（中位数成本为15,984澳元）。无论是经医院治疗还是门诊治疗的骨折，男性和女性的成本均无显著差异。康复医院成本占医院治疗骨折成本的最大比例（49%）。社区服务占门诊治疗骨折的主要成本（40%）。成本的单变量预测因素是股四头肌力量和骨密度，尽管多变量分析显示股四头肌力量是成本的最佳总体预测因素。在澳大利亚，60岁及以上人群发生的非创伤性骨折的预计年度治疗成本为7.79亿澳元，即每年每百万人口约4400万澳元。澳大利亚人群与骨质疏松性骨折相关的估计总成本远高于此前报告的数字。大部分直接成本（95%）由住院患者产生，与医院和康复成本相关。这些数据的推断表明，到2025年，大多数西方国家仅髋部骨折的直接成本将增加约两倍。提高治疗骨质疏松性骨折的成本效益应包括减少住院时间和/或提高社区康复服务的效率。必须将各种骨质疏松症预防方法的成本置于这些直接成本的背景下，并且预防应针对男性和女性。
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