AIMS: To determine the incremental cost of health care and clinical outcomes in the 12 months following incident selected fractures [NVNHF, vertebral (VF) and multiple(MF)] in postmenopausal women in the UK.
METHODS: Cohort study of women aged ≥50 years with incident selected fractures, individually matched on age and comorbidity to women without fractures. Cohorts were identified from The Health Improvement Network database from 2001 to 2005. Follow- up started from the fracture date for the cases and same calendar date for the matched controls, to the earliest of 12 months after start date, death, or end of enrollment. We examined health care resource utilization (HCRU) and estimated 1-year incremental costs associated with each fracture type. Costs included hospitalizations, general practitioner (GP) and accident and emergency visits, referrals and prescription of medications. Descriptive analysis were performed on occurrence of subsequent fractures and death.
RESULTS: 14,030 women had a NVNHF (including 7,070 wrist/ forearm and 2,545 humerus fractures), 1,471 had a VF, and 193 had MF. During the 1-year follow-up, greater proportion of women in the fracture cohorts was hospitalized, prescribed medications, visited a GP or emergency facilities, or had referral to a specialist than women in non-fracture cohorts. The rate of subsequent fractures was 12% in the NVNHF cohort and 6% in women with VF or MF. The risk of death was greater among women with fractures than women in non-fracture cohorts. Relative risks (RR) for mortality: VF, 1.7 (95% CI: 1.3-2.2); NVNHF, 1.6 (95% CI: 1.4-1.7); and MF 2.7 (95% CI: 1.3-5.4). The overall mean cost of HCRU per woman were: VF, £2,180, NVNHF, £1,604 and MF, £3,648. The overall mean incremental cost were: VF, £1,152 (95% CI: £1,030-£1,274), NVNHF, £690 (95% CI; £653-£726) and MF, £2,581 (95% CI: £2,148-,015). Hospitalizations represented 54% (VF), 77% (NVNHF), and 90% (MF) of the total incremental cost in each respective cohort. Cost of medications made up to 29% (VF), 10% (NVNHF) and 7% (MF) of the total incremental cost respectively. Most of the total annual costs concentrated in the 6 months after the date of fracture in all cohorts.
CONCLUSIONS: The costs of HCRU is higher among women with fractures than among women in the non-fracture cohorts. Hospitalizations are the main driver of the cost associated with the care of fractures in postmenopausal women. Mortality in women with selected fractures is also higher than in women in the nonfracture cohorts.
