Direct medical costs attributable to peripheral fractures in Canadian post-menopausal women

Abstract

Summary

This study determined the cost of treating fractures at osteoporotic sites (except spine fractures) for the year following fracture. While the average cost of treating a hip fracture was the highest of all fractures ($46,664 CAD per fracture), treating other fractures also accounted for significant expenditures ($5,253 to $10,410 CAD per fracture).

Introduction

This study aims to determine the mean direct medical cost of treating fractures at peripheral osteoporotic sites in the year post-fracture (through 2 years post-hip fracture).

Methods

Health administrative databases from the province of Quebec, Canada were used to estimate the cost of treating peripheral fractures at osteoporotic sites for the year following fracture (through 2 years for hip fractures). Included in costs analyses were physician claims, emergency and outpatient clinic costs, hospitalization costs, and subsequent costs for treatment of complications.

Results

A total of 15,827 patients (mean age 72 years) who suffered one fracture at an osteoporotic site had data for analyses. Hip/femur fractures had the highest rate of hospital stays related to fracture (91%) and the highest rate of hospital stays associated with a post-fracture complication (8%). In the year following fracture, the mean (SD) costs (2009 Canadian dollars) of treating acute fractures and post-fracture complications were: hip/femur fracture $46,664 ($43,198), wrist fracture $5,253 ($18,982), and fractures at other peripheral sites $10,410 ($27,641). The average (SD) cost of treating post-fracture complications at the hip/femur in the second year post-fracture was $1,698 ($12,462). Hospitalizations associated with the fracture accounted for 88% of the total cost of fracture treatment.

Conclusions

The treatment of hip fractures accounts for a significant proportion of the costs associated with the treatment of peripheral osteoporotic fractures. Interventions to reduce the incidence of fractures, particularly hip fractures, would result in significant cost savings to the health care system and would preserve quality of life in many patients.

Appendices

Appendix 1

Classification of principal diagnostic codes at hospitalization.

Table 6 Selection of hospital stays

Appendix 2

Selection of hospital stays^a.

^aUnshaded cells with hospitals stays unrelated to the fracture were not used in the cost analysis. Dark gray-shaded cells with hospital stays considered definitively related to the fracture and pale gray-shaded cells with hospitals stays considered as related to a complications.

^bDefinition of time between hospital admission and fracture differ between fracture site:

• Hip fracture: direct = 0–14 days, possible = 15–180 days, first year = 181–365 days, second year 365–730 days

• Pelvis, knee, tibia/fibula: direct = 0–10 days, possible = 11–180 days, first year = 181–365 days

• Shoulder/humerus, forearm/elbow, wrist, foot, ankle: direct = 0–10 days, possible = 11–120 days, first year = 121–365 days

^cDefinitions of what is considered a principal diagnostic code for fracture, associated to a fracture, of a complication of fracture are given in Appendix 1.