Prolonged effects from osteoporotic fractures drive health care, indirect costs
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Women who sustain any type of osteoporotic fracture have higher adjusted all-cause health care costs and indirect costs in the 5 years after fracture compared with matched nonfracture controls, according to a speaker.
Osteoporotic fractures are associated with substantial economic burden during the first year, regardless of fracture type, Oth Tran, MA, a health economics and outcomes researcher in life sciences, value-based care for IBM Watson Health, said during an online presentation at the virtual American Society for Bone and Mineral Research Annual Meeting. Studies assessing the prolonged effects on patient health and ensuing long-term costs after osteoporotic fracture are underreported, he said.
“Osteoporotic fracture can lead to a general decline in patient health and cause long-lasting economic burden to patients and the health care system,” Tran told Healio. “Osteoporosis and osteoporotic fracture are not just impacting elderly patients. Working-age women incurred high indirect costs due to productivity loss and short-term disabilities following the fracture.”
Tran and colleagues identified women aged at least 50 years with incident osteoporotic fracture stratified by type (hip, vertebral and nonvertebral) from 2008 to 2016, using claims data from MarketScan Commercial and Medicare databases. Follow-up began after the first identified fracture event through 2017. Researchers matched patients with nonfracture controls based on age, geographic region, years of follow-up and insurance type. Researchers used general linear models to compare total direct health care costs (inpatient, outpatient and prescription) from years 1 through 5 between fracture patients and controls, adjusted for baseline costs, comorbidities, osteoporosis diagnosis and treatment; costs were standardized to 2019 U.S. dollars.
Researchers found that prefracture osteoporosis diagnoses and treatment rates were low among both commercially enrolled and Medicare supplemental patients.
Compared with controls, fracture patients had higher adjusted all-cause health care costs across all 5 years after fracture. Among commercially insured patients vs. controls, unadjusted all cause health care costs for patients who sustained a hip fracture were $86,427 vs. $9,057 for year 1; $39,136 vs. $10,399 for year 2; $33,634 vs. $10,479 for year 3; $32,234 vs. $10,756 for year 4; and $27,826 vs. $8,991 for year 5.
Among patients with Medicare vs. controls, unadjusted all-cause health care costs for patients who sustained a hip fracture were $64,846 vs. $14,137 for year 1; $26,212 vs. $14,535 for year 2; $25,794 vs. $14,655 for year 3; $25,731 vs. $15,086 for year 4; and $25,979 vs. $14,883 for year 5.
Cost disparities were similar among commercially insured and Medicare patients who sustained vertebral fractures and nonvertebral fractures across 5 years, Tran said.
Additionally, patients with each type of fracture had higher indirect costs due to work absence and short-term disability compared with fracture-free controls during the first year after fracture, Tran said.
“The most surprising data was that, even after the first year, health care costs for fracture patients compared with their demographically similar controls were still higher from years 2 through 5,” Tran said in an interview.
Tran said early identification of high-risk patients and continued management are needed. “Osteoporosis treatment should not be held off until a fracture occurred,” Tran said. “We need to identify osteoporosis and low bone mass early. Then, we can have early treatment and continued management.”
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Tran O, et al. Uncovering the total costs of osteoporosis-related fractures in US postmenopausal women. Presented at: American Society for Bone and Mineral Research Annual Meeting; Sept. 11-15, 2020 (virtual meeting).
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