Vertebral fractures which come to clinical attention

The cost of these fractures - i.e., those for which the patient visits a doctor because of pain - can be divided into those that lead to hospitalization and all clinical fractures.

Hospitalized vertebral fractures

Gehlbach et al. [5] studied the resource implications of hospitalization for osteoporosis-related vertebral fractures. They used data from national samples of patients with hospitalized fractures, mainly from discharge databases. Patients with metastatic cancer or severe trauma were excluded. The total charges averaged USD 8000-10000 per hospi-talization and were higher in men. The length of stay was just under 6 days, and more than 50% of discharged patients required some form of continuing care, indicating that the overall cost is much higher than just the hospital-ization. These costs were gathered from a US database where vertebral fracture accounted for over 400 000 total hospital days and generated charges in excess of USD 500 million. In total, vertebral fractures were responsible for almost 70 000 annual hospitalizations, about one-fourth of the number due to hip fractures, and it was found that the average total charge for vertebral fracture hospitalization was about half of that of hospitalization due to hip fracture. However, the average length of stay was shorter for vertebral fracture than for hip fracture.

In a study from Europe the hospital cost of vertebral fractures was estimated using national data sets [3]. In that study there was a marked difference in length of stay, ranging from 0.3 days in Austria to 20.2 days in Spain. The total cost of vertebral fractures in the European Union was estimated at € 377 million per year, and across the European Union the hospital cost of vertebral fractures was on average 63% that of a hip fracture. The cost estimate was done using the average cost per day in hospital in the various countries. The hospitalization rate for vertebral fracture was estimated at 8%.

All clinical fractures

A pilot study for all vertebral fractures coming to clinical attention has been done in Sweden, where patients were followed prospectively for 1 year in order to assess the reduction in quality of life and also the costs [7]. The study in cluded hip fractures, clinical vertebral fractures, wrist fractures, and shoulder fractures. At baseline there were only 42 vertebral fractures. The quality of life reduction was similar to that with hip fractures. The cost did not include all nursing home costs and therefore the total cost will be higher. The total costs for this small group of vertebral fractures were: direct costs SEK30000, and indirect costs SEK31 000, i.e., an annual total cost of SEK61000. On the basis of this pilot study a large study has been started.

In a recent study from the Mayo clinic [6], the incremental cost in a case-control series was calculated for os-teoporotic fractures. In this study, too, nursing home patients were not included. For 283 vertebral fractures, the incremental cost in the case-control study was almost USD 2000 per year.

Thus, the estimates of cost to society are only preliminary. The definitive data for vertebral fractures are still being acquired. It may be concluded that radiological fractures have an increased incremental cost of USD 500 per year. For hospitalized fractures, the cost is higher than expected - in a US study, up to USD 10 000 during the first year - and, surprisingly, this is roughly half the cost of a hip fracture. The rehabilitation cost is not included in this. In a European study it was also noted that the hospitalization cost of vertebral fractures was more than 50% of the average cost of a hip fracture, and that the total yearly cost of hospitalized vertebral fractures in the European Union was estimated at € 377 million per year. It is more difficult to estimate the total cost of all clinical vertebral fractures. A pilot study has shown a rather high amount in Sweden, with direct costs of SEK 30000 and indirect costs that are almost as high. A new large study has been started to verify this in a larger population. In a US study the incremental cost was USD 2000 per fracture per year. All this indicates that the cost of vertebral fractures has been underestimated; it is high, and is substantial even in compraison to hip fractures.

These new data showing a higher cost than expected, and also a greater loss of quality of life then previously calculated, will have an impact on health economy calculations. In the future, prevention of only vertebral fractures might be cost-effective on the basis of these data.

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