Johnell O
Department of Orthopaedics, Malmö University Hospital, Sweden.
Am J Med. 1997 Aug 18;103(2A):20S-25S; discussion 25S-26S. doi: 10.1016/s0002-9343(97)90023-1.
Hip fractures are a burden to both the individual and the community. Only 50% of patients regain the mobility and independence they enjoyed 12 months before the hip fracture occurred. Direct costs are high: about US$7,000 for the immediate hospital care and $21,000 in total costs for the first year. The numbers of hip fractures worldwide are projected to increase from 1.7 million in 1990 to 6.3 million in 2050 because of the aging of the population; therefore, the total cost of these fractures will also increase. Based on today's currency values and a cost of $21,000 per patient, the total cost of hip fractures in the year 2050 will be $131.5 billion. The costs and morbidity associated with other fractures, such as vertebral fractures, are less well defined. Because hip fractures are associated with the highest and most well-defined costs, morbidity, and mortality of all fragility fractures, models with high sensitivity can now be devised for evaluating the costs and benefits of interventions. These models are constructed using data on incidence, morbidity, mortality, and costs of fractures, along with the efficacy of an intervention, to estimate the impact of that intervention against osteoporosis. According to one model, the cost per hip fracture avoided is $48,600 if a 62-year-old woman with osteoporosis receives treatment with a drug that is administered for 5 years at $830/year and produces a 50% reduction in fracture rate. The cost per life-year saved is $30,600, and the cost per quality-adjusted life-year is $14,900. By comparison, using this model, treatment of a 62-year-old woman with a diastolic pressure of 95 mm Hg using a drug costing $420/year that reduces risk of stroke by 38% results in costs of $144,200 per stroke avoided, $17,800 per life-year saved, and $14,300 per quality-adjusted life-year. Health economic models allow for changes in assumptions, such as extent of compliance, effectiveness of therapy, and risk of side effects. Cost-effectiveness varies according to treatment and is highly sensitive to the estimated efficacy of treatment, patient compliance, age of the patient at the start of treatment, and fracture risk assigned to the patient. Greater cost-effectiveness occurs when treatments are more efficacious and when they are directed at patients with the highest risk of fracture.
髋部骨折对个人和社会来说都是一种负担。只有50%的患者能够恢复到髋部骨折发生前12个月时的活动能力和独立生活状态。直接费用高昂：即时住院护理费用约为7000美元，第一年的总费用为21000美元。由于人口老龄化，全球髋部骨折的数量预计将从1990年的170万例增加到2050年的630万例；因此，这些骨折的总费用也将增加。按照当前货币价值计算，每位患者的费用为21000美元，2050年髋部骨折的总费用将达到1315亿美元。与其他骨折（如椎体骨折）相关的费用和发病率则不太明确。由于髋部骨折在所有脆性骨折中具有最高且定义最明确的费用、发病率和死亡率，现在可以设计出高灵敏度模型来评估干预措施的成本和效益。这些模型利用骨折的发病率、发病率、死亡率和费用数据，以及干预措施的疗效，来估计该干预措施对骨质疏松症的影响。根据一个模型，如果一名62岁患有骨质疏松症的女性接受一种每年费用为830美元、服用5年且能使骨折率降低50%的药物治疗，那么避免每例髋部骨折的成本为48600美元。每挽救一个生命年的成本为30600美元，每获得一个质量调整生命年的成本为14900美元。相比之下，使用这个模型，为一名舒张压为95毫米汞柱的62岁女性使用一种每年费用为420美元、能使中风风险降低38%的药物进行治疗，每避免一次中风的成本为144200美元，每挽救一个生命年的成本为17800美元，每获得一个质量调整生命年的成本为14300美元。健康经济模型允许改变假设，如依从程度、治疗效果和副作用风险。成本效益因治疗方法而异，并且对治疗的估计疗效、患者依从性、治疗开始时患者的年龄以及赋予患者的骨折风险高度敏感。当治疗更有效且针对骨折风险最高的患者时，成本效益更高。
