Economic Burden Of Osteoporosis Research Articles

Estimating the future clinical and economic benefits of improving osteoporosis diagnosis and treatment among postmenopausal women across eight European countries

SummaryA population-level, cross-sectional model was developed to estimate the clinical and economic burden of osteoporosis among women (≥ 70 years) across eight European countries. Results demonstrated that interventions aimed at improving fracture risk assessment and adherence would save 15.2% of annual costs in 2040.PurposeOsteoporosis is associated with significant clinical and economic burden, expected to further increase with an ageing population. This modelling analysis assessed clinical and economic outcomes under different hypothetical disease management interventions to reduce this burden.MethodsA population-level, cross-sectional cohort model was developed to estimate numbers of incident fractures and direct costs of care among women (≥ 70 years) in eight European countries under different hypothetical interventions: (1) an improvement in the risk assessment rate, (2) an improvement in the treatment adherence rate and (3) a combination of interventions 1 and 2. A 50% improvement from the status quo, based on existing disease management patterns, was evaluated in the main analysis; scenario analyses evaluated improvement of either 10 or 100%.ResultsBased on existing disease management patterns, a 44% increase in the annual number of fractures and costs was predicted from 2020 to 2040: from 1.2 million fractures and €12.8 billion in 2020 to 1.8 million fractures and €18.4 billion in 2040. Intervention 3 provided the greatest fracture reduction and cost savings (a decrease of 17.9% and 15.2% in fractures and cost, respectively) in 2040 compared with intervention 1 (decreases of 8.7% and 7.0% in fractures and cost, respectively) and intervention 2 (10.0% and 8.8% reductions in fracture and cost, respectively). Scenario analyses showed similar patterns.ConclusionThese analyses suggest that interventions which improve fracture risk assessment and adherence to treatments would relieve the burden of osteoporosis, and that a combination strategy would achieve greatest benefits.

Commentary: Zebrafish as a Model for Osteoporosis—An Approach to Accelerating Progress in Drug and Exercise-Based Treatment

Osteoporosis (OP) is a degenerative disease characterized by reduced bone strength and increased fracture risk. As the global population continues to age, the prevalence and economic burden of osteoporosis can be expected to rise substantially, but there remain various gaps in the field of OP care. For instance, there is a lack of anti-fracture drugs with proven long-term efficacy. Likewise, though exercise remains widely recommended in OP prevention and management, data regarding the safety and efficacy for patients after vertebral fracture remain limited. This lack of evidence may be due to the cost and inherent difficulties associated with exercise-based OP research. Thus, the current research landscape highlights the need for novel research strategies that accelerate OP drug discovery and allow for the low-cost study of exercise interventions. Here, we outline an example of one strategy, the use of zebrafish, which has emerged as a potential model for the discovery of anti-osteoporosis therapeutics and study of exercise interventions. The strengths, limitations, and potential applications of zebrafish in OP research will be outlined.

P10 Treating osteoporosis, facing reality – adopting a holistic approach

Case report - IntroductionOsteoporosis is a significant health problem; globally around 200 million women are affected. In Europe, osteoporosis is responsible for a higher disability encumber than cancer (with the exception of lung cancer). The treatment of osteoporosis is quite exacting. Although understanding of the diagnosis and treatment of osteoporosis has broadened considerably over the last few years, lack of bridging information still exists with guidance lacking on the appropriate management of complex comorbid clinical scenarios.Here we will present a scenario of a patient with osteoporosis and multiple risk factors and comorbidities, where choice of suitable anti osteoporotic treatment was quite challenging.Case report - Case descriptionAn 84-year-old lady with known osteoporosis with history of T-12 fracture (in 2009), sarcoidosis, coeliac disease (confirmed on duodenal biopsy), chronic hepatitis, history of acute kidney injury secondary to zoledronic acid infusion and urosepsis in 2017 was re-referred to the rheumatology clinic from respiratory team for optimisation of her bone protection.She was previously on risedronate for almost 5 years without any improvement of bone mineral density. She was last seen in rheumatology in 2018, because of ineffectiveness and intolerance to alendronate (gastritis) and intravenous zoledronate – a discussion about subcutaneous denosumab was had, but the patient refused that option because of needle phobia. So, the plan was to maintain her on optimisation of vitamin D and calcium level. She was discharged from the clinic. Her GP advised her against vitamin D or calcium supplements because of episodes of hypercalcaemia secondary to sarcoidosis. For the last 3 years she was not on any bone protection or even calcium or vitamin D supplements.Recently she noticed a worsening of exertional dyspnoea. She was reviewed by the respiratory team. Her lung function test showed slow progression of restrictive lung disease with FEV1/FVC ratio is 100.4%. In December 2020, she was started on prednisolone 30mg, which gradually stepped down; at the moment, she is on 15mg and will continue it as maintenance.The patient was an ex-smoker, and drinks alcohol at about 10 unit/week. Her mobility is slightly better compared to the last few years. She trys to keep active and is enjoy gardening in the sunny weather. It was difficult to convince her for blood tests; however, we succeeded after repeated counselling. Her blood tests showed microcytic anaemia, with normal inflammatory markers mild renal impairment with eGFR of 67, corrected calcium 2.19, alkaline phosphatase 78, vitamin D 49 (sub optimal) albumin 32.Case report - DiscussionConsidering her age, comorbidities, frailty, intolerance and doubt about the efficacy, selecting an appropriate bone protection for her was fairly hard. Starting denosumab had more risk than benefit and in future if it need to stop there is an increased chance of rebound fracture. Besides this, she re-expressed her reluctance to the subcutaneous option. Moreover, calcium and vitamin D level were low in her recent blood tests. She did not fulfil the criteria for considering teriperatide. We reviewed her DEXA scan in 2018, which showed an overall 19% reduction of BMD compared to 2009 (1.6% per year). She was on risedronate intermittently for about 4 years that time; however, she had not experienced any new fracture at that point. She had multiple hospital admissions during those years. Bone protection was withheld multiple times. Poor mobility, frailty status and other comorbidities during that period were also responsible for BMD decline. Her case was discussed with a consultant with special interest in metabolic bone disease. Treatment decisions should be individualised; risk versus benefit needs to be considered to ensure the best outcome for the patient. We have decided to put her back on risedronate for at least 3 years. She tolerated only this medication in the past. We have requested bone markers and a repeat DEXA scan. Case report - Key learning pointsComorbidities adversely affect the management of osteoporosis. A comprehensive assessment of the comorbid list is necessary before considering changing a medication which suits the patient well and when there is limited option. Obstacles to offer high quality service are knowledge, expertise, and critical thinking from healthcare professionals, and knowledge and compliance to treatment from patients. Facing those challenges and treating patients judiciously will help to reduce the potential health and economic burden of osteoporosis.

Estimating the future clinical and economic benefits of improving osteoporosis diagnosis and treatment among women in South Korea: a simulation projection model from 2020 to 2040.

The economic burden of osteoporosis was US $5.1B in 2011 in South Korea. Osteoporosis is expected to strain resources in South Korea as the population most susceptible to osteoporotic fracture, females > 50years old, is projected to increase by 32% from 2020 to 2040. A microsimulation model was developed to project annual incidence and costs of osteoporotic fractures among postmenopausal women from 2020 to 2040. Fracture risk was estimated using the simplified Fracture Risk Assessment Tool (FRAX). The fracture estimates were based on annualized FRAX risk and impact of treatment. Korean National Health Insurance data informed treatment and case-finding rates in the reference case. Two scenarios were evaluated: 50% increases to (i) case finding (screening rate and subsequent treatment rate) and (ii) treatment rate among those at highest risk. Among individuals modeled in the reference case from 2020 to 2040, 41.2M fractures at a cost of US $263.6B were projected. Increased treatment scenario prevented 4.4M fractures and saved US $13.5B. Increased case-finding scenario prevented 4.0M fractures and saved US $11.1B. Implementation of policies to enable increasing case finding or treatment may result in fewer fractures and substantial cost savings across the healthcare system. These results highlight the importance of early screening, diagnosis, and preventive treatment.

Gender Disparities in Osteoporosis Screening and Management Among Older Adults.

One in two women and one in four men experience an osteoporosis-related fracture in their lifetime. Related morbidity and mortality rates are higher in men versus women. Current guidelines are inconsistent in the screening recommendations for osteoporosis in men. Examination of gender disparities in the management of osteoporosis-related fractures among Medicare enrollees is currently lacking. In this retrospective cohort study using 5% National Medicare claims data from January1, 2012 through December31, 2016, eligible patients who were at least 65years of age on the date of a new fracture episode were classified into two mutually exclusive cohorts on the basis of whether they received testing and/or treatment for osteoporosis in the 6-month period after the new fracture episode. The cohorts were defined on the basis of the National Committee for Quality Assurance (NCQA) quality measure "osteoporosis management in women who had a fracture." Patients were followed to identify the occurrence of subsequent fracture, all-cause mortality, and a composite outcome-defined as the first occurrence of either subsequent fracture or mortality. Logistic regression models were carried out to identify predictors of testing and/or treatment and time-varying survival analysis to identify the relationship between the presence of testing and/or treatment and patient outcomes. Of the 35,774 eligible patients, only 10.2% (12.1% women and 5.7% men) received osteoporosis testing and/or treatment within 6months after a fracture. The interaction between gender and fragility fracture was significant (P < 0.0001). Fragility fracture had greater adjusted odds of testing and/or treatment among men (adjusted odds ratio [AOR] 3.47; 95% CI 2.94-4.10) than women (AOR 1.65; 95% CI 1.53-1.79). Of patients who were eligible for the outcome assessment, 27.5% experienced a subsequent fracture, 23.2% died, and 44.3% experienced a composite outcome during follow-up. Patients who received testing and/or treatment had a significantly lower hazard of all-cause mortality (hazard ratio [HR] 0.57; 95% CI 0.50-0.65; P < 0.0001) and the composite outcome (HR 0.42; 95% CI 0.39-0.45; P < 0.0001), but no difference in the risk of subsequent fracture (HR 1.02; 95% CI 0.94-1.11; P = 0.6083). Men were found to have a significantly lower hazard of subsequent fracture (HR 0.69; 95% CI 0.64-0.73; P < 0.0001), all-cause mortality (HR 0.67; 95% CI 0.61-0.72; P < 0.0001), and the composite outcome (HR 0.69; 95% CI 0.65-0.73; P < 0.0001). Testing and/or treatment for osteoporosis among older adults with a fracture is poor in the Medicare fee-for-service population overall and worse for men compared to women. Receiving appropriate testing and/or treatment was associated with reduced mortality and the risk of composite outcome. Improving osteoporosis testing and/or treatment and reducing health disparities are essential for managing the clinical and economic burden of osteoporosis in the USA.

Environmental substances associated with osteoporosis

Abstract Background Osteoporosis is a disease adversely affecting the bone health and causing fragility fractures. Osteoporosis is affecting the lives of approximately 200 million people worldwide and causing nearly 9 million fractures annually. In the European Union the economic burden of osteoporosis and prior fragility fractures was estimated at €37 billion in 2010; the costs are predicted to double by the year 2050. The disease takes both personal and economic toll by causing significant disability and increasing health-care costs as the population ages. There is evidence, that certain environmental substances may increase the risk of osteoporosis. Methods In the framework of the European Human Biomonitoring Initiative (HBM4EU) a set of 18 priority substances and substance groups were selected to be further studied. Within HBM4EU a scoping document has been prepared for each of the substance groups. Based on a review of the recent literature, a scoping review of substances which might be associated with osteoporosis was prepared. Results The literature research revealed that there is a possible link of osteoporosis and heavy metals such as cadmium and lead. Additionally, for phthalates and per- and poly-fluoroalkyl substances (PFASs), a potential association was observed. Especially women in perimenopausal and postmenopausal stage have been identified as being at greater risk of harmful effects. Other substances such as bisphenols, arsenic, mercury and polycyclic aromatic hydrocarbons (PAHs) are suspected to have adverse effects on bone health but the evidence is still incomplete. Conclusions Although there is some evidence that these environmental substances have an adverse effect on human health, more research is needed. Some of the evidence is inconsistent, and there is a lack of extensive epidemiological studies. Since people are exposed to many substances simultaneously, there is a need to initiate studies which attempt to clarify the possible combined effects. Key messages Exposure to cadmium, lead, phthalates and PFASs may adversely affect bone health and increase a risk of osteoporosis. An inverse association of chemicals and bone mineral density is often detected. The growing concern of chemical exposure requires initiating of epidemiological studies on the subject. Multidisciplinary action for safeguarding citizenś health in Europe and worldwide is needed.

The health and economic burden of osteoporotic fractures in Singapore and the potential impact of increasing treatment rates through more pharmacological options.

This study aims to estimate the health and economic burden of osteoporosis in Singapore from 2017 to 2035, and to quantify the impact of increasing the treatment rate of osteoporosis. Population forecast data of women and men aged 50 and above in Singapore from 2017 to 2035 was used along with prevalence rates of osteoporosis to project the osteoporosis population over time. The population projections by sex and age group were used along with osteoporotic fracture incidence rates by fracture type (hip, vertebral, other), and average direct and indirect costs per case to forecast the number of fractures, the total direct health care costs, and the total indirect costs due to fractures in Singapore. Data on treatment rates and effects were used to model the health and economic impact of increasing treatment rate of osteoporosis, using different hypothetical levels. Between 2017 and 2035, the incidence of osteoporotic fractures is projected to increase from 15,267 to 24,104 (a 57.9% increase) F 10,717 to 17,225 (a 60.7% increase) and M 4550 to 6878 (a 51.2% increase). The total economic burden (including direct costs and indirect costs to society) associated with these fractures is estimated at S$183.5 million in 2017 and is forecasted to grow to S$289.6 million by 2035. However, increasing the treatment rate for osteoporosis could avert up to 29,096 fractures over the forecast period (2017-2035), generating cumulative total cost savings of up to S$330.6 million. Efforts to improve the detection, diagnosis, and treatment of osteoporosis are necessary to reduce the growing clinical, economic, and societal burden of fractures in Singapore.

Bone Mineral Density in Obstructive Sleep Apnea and Obesity

BackgroundOsteoporosis, a condition associated with decreased bone density, contributes significantly to morbidity and mortality. Importantly, the incidence and economic burden of osteoporosis is rising partly due to increases in the aging population. Moreover, while the role of obesity on bone health is controversial, studies suggest that obesity alters bone density. Effects of obstructive sleep apnea (OSA), which is more prevalent in ageing and obesity, on any relationship between obesity and BMD are not well known.ObjectiveTo examine the effects of BMI and OSA on total and regional bone density.MethodsA database of all research participants with nocturnal polysomnography and whole body dual energy X‐Ray absorptiometry scan (DEXA) was created. The study population included 72 subjects without OSA (AHI&lt;5, Age: 29.1 ± 7.3 years, BMI: 24.3 ± 3.6 Kg/m2) and 22 subjects with OSA (apnea hypopnea index, AHI&gt;5; 4 females, Age: 43.3 ± 11.2 years, BMI: 30.8 ± 4.1 Kg/m2). We examined the relationship between BMI and BMD in all our subjects. Linear regression models adjusted for age and BMI were used to assess changes in bone density in the presence of OSA. Additional analyses examining the effects of OSA in overweight and obese individuals (BMI&gt;25 kg/m2) and relationship between BMI and BMD in OSA subjects were also undertaken.ResultsTotal body bone density in all our study subjects was positively correlated with BMI (Std Beta = 0.42, 95% CI 0.004 – 0.015, p &lt; 0.001) but not age (Std Beta = 0.04, 95% CI −0.002 −0.003, p = 0.71) or presence of OSA (Std Beta = 0.042, −0.029 − 0.040, p = 0.75). Similarly, bone density in spine was increased with increases in BMI (Std Beta = 0.45, 95% CI 0.006 − 0.019, p = 0.0003) and not affected by age (Std Beta = 0.14, 95% CI −0.001 – 0.005, p = 0.23) or presence of OSA (Std Beta = 0.18, 95% CI −0.011 – 0.065, p = 0.16). Also, increases in BMD in pelvic region were only associated with BMI (Std Beta = 0.30, 0.001 – 0.019, p = 0.024). Age (Std Beta = −0.09, −0.005 – 0.002, p = 0.45) or presence of OSA (Std Beta = 0.19, −0.016 – 0.086, p = 0.17) did not alter BMD in pelvic area. Interestingly, overweight and obese subjects with OSA had a lower pelvic BMD compared to overweight and obese subjects without OSA (1.10 ± 0.12 g/cm3 Vs. 1.19 ± 0.16 g/cm3, p = 0.043), even when OSA subjects had a higher BMI (31.4± 3.7 kg/m2 Vs. 27.8± 3.2 Kg/m2, p = 0.001) and were older (43.4 ± 11.3 years Vs 30.6 ± 8.8 years, p&lt;0.001). Also, the positive relationship between BMI and BMD was not present in OSA subjects in our study population (Total BMD: p = 0.73; Spine BMD: p = 0.94; Pelvic BMD: p=0.77).ConclusionA positive association between bone density and BMI was observed in our study population. However, this relationship was not evident in OSA subjects. Further, our study suggests that OSA may be accompanied by decreased bone density in the pelvic region. Cross‐sectional and longitudinal studies examining the effects of OSA on regional bone density, fractures, and frailty in BMI, age and gender matched populations are warranted.Support or Funding InformationVKS and PS are supported by NIH grant HL65176This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

PMS29 - The Health and Economic Burden of Osteoporosis and Impact of Effective Treatment In Singapore

PMS29 - The Health and Economic Burden of Osteoporosis and Impact of Effective Treatment In Singapore

Age- and gender-specific epidemiology, treatment patterns, and economic burden of osteoporosis and associated fracture in Taiwan between 2009 and 2013.

This nationwide study investigated the epidemiology, treatment patterns, and economic burden of osteoporosis and associated fracture between 2009 and 2013 in Taiwan. We used the National Health Insurance Research Database as our data source. The prevalence of diagnosed osteoporosis and major osteoporotic fractures was calculated annually from 2009 to 2013, stratified by age and gender. Osteoporosis patients who received any prescription of anti-osteoporosis drugs during each fiscal year were defined as osteoporosis patients under treatment. Healthcare utilization and associated direct medical costs were used to quantify the economic burden of osteoporosis. For patients who encountered major osteoporotic fracture, the incremental changes of direct medical costs attributable to fracture using a pre- and post-quasi-experimental design were estimated. Furthermore, we compared the annual direct medical costs of patients who encountered major osteoporotic fracture with those diagnosed osteoporosis only and with the general population. The prevalence of diagnosed osteoporosis increased with age, with the highest rate among those aged 80 and older. Overall, less than one-third of women and only 10% of men received anti-osteoporosis drugs among osteoporosis patients. The annual direct medical costs for osteoporosis patients increased steadily from 2009 to 2013. The total medical costs and incremental change of direct medical costs were higher in men than those in women. We found the treatment of osteoporosis to be alarmingly suboptimal, considering the significantly increased economic burden of major osteoporotic fracture also identified in this study. Osteoporosis men received lesser anti-osteoporosis drugs but had higher incremental costs attributable to major osteoporotic fractures.

Epidemiology and economic burden of osteoporosis in Switzerland.

This report describes the epidemiology, economic burden and treatment of osteoporosis in Switzerland. Osteoporosis is characterized by reduced bone mass and disruption of bone architecture, resulting in increased risks of fragility fractures which represent the main clinical consequence of the disease. Fragility fractures are associated with substantial pain and suffering, disability and even death for the affected patients and substantial costs to society. The aim of this report is to describe the epidemiology and economic burden of fragility fractures as a consequence of osteoporosis in Switzerland, as a detailed addition to the report for the European Union (EU27): "Osteoporosis in the European Union: Medical Management, Epidemiology and Economic Burden". The literature on fracture incidence and costs of fractures in Switzerland was reviewed and incorporated into a model estimating the clinical and economic burden of osteoporotic fractures in 2010. Furthermore, data on sales of osteoporosis treatments and the population at high risk of fracture were used to estimate treatment uptake and treatment gap. It was estimated that approximately 74,000 new fragility fractures were sustained in Switzerland in 2010, comprising 14,000 hip fractures, 11,000 vertebral fractures, 13,000 forearm fractures and 36,000 other fractures (i.e. fractures of the pelvis, rib, humerus, tibia, fibula, clavicle, scapula, sternum and other femoral fractures). The economic burden of incident and previous fragility fractures was estimated at CHF 2,050 million for the same year. Incident fractures represented 76% of this cost, long-term fracture care 21% and pharmacological prevention 3%. Previous and incident fractures also accounted for 24,000 quality-adjusted life years (QALYs) lost during 2010. When accounting for the demographic projections for 2025, the number of incident fractures was estimated at 98,786 in 2025, representing an increase of 25,000 fractures. Hip, clinical vertebral (spine), forearm and other fractures were estimated to increase by 4,900, 3,200, 3,500 and 13,000, respectively. The burden of fractures in terms of costs (excluding value of QALYs lost) in Switzerland in 2025 was estimated to increase by 29% to CHF 2,642 million. Though the uptake of osteoporosis treatments increased from 2001, the proportion of patients aged 50 or above who received treatment remained at low levels in the past few years. The majority of women at high fracture risk do not receive active treatment. In spite of the high cost of osteoporosis, a substantial treatment gap and projected increase of the economic burden driven by an aging population, the use of pharmacological prevention of osteoporosis is significantly less than optimal, suggesting that a change in health care policy concerning the disease is warranted.

Epidemiology and Economic Burden of Osteoporosis in South Korea

Epidemiology and Economic Burden of Osteoporosis in South Korea

Current and Future Economic Burden of Osteoporosis in New Zealand

Current and Future Economic Burden of Osteoporosis in New Zealand

The knowledge of osteoporosis risk factors in a Greek female population

Objectives The social and economic burden of osteoporosis is important since it concerns a continuously aging population, while the disease is silent until the emergence of fractures. Aim of the study was to assess female population knowledge about osteoporosis risk factors and to identify the risk factors of the studied population. Methods A sample of 99 (aged: 61.59 ± 9.61 years) women under treatment for osteoporosis or osteopenia answered the questionnaire provided by their pharmacists and were included in the study's analysis. Various parameters on osteoporosis awareness and risk factor knowledge of the population sample studied were analyzed. Results It was revealed that 96% of the participants knew osteoporosis definition and sources of this knowledge were one or more of the following: doctors (86.3%), mass media (20%) and friends or relatives (13.7%). It was found that the older age was associated with less knowledge (OR = 0.93, CI: 0.88–0.97, p = 0.004), and higher education with increased knowledge (OR = 1.68, CI: 1.10–2.55, p = 0.014) about osteoporosis. 56.4% of the participants were aware of at least one osteoporosis risk factor. In multivariate analysis, it was revealed that the participants who referred increased milk products consumption in childhood (OR = 3.72, CI: 1.34–10.36, p = 0.012) and current performance of physical activity (OR = 13.06, CI: 3.22–53.05, p < 0.001) were more likely to be informed about osteoporosis risk factors; age >61 years was associated with decreased knowledge of risk factors (OR = 0.27, CI: 0.09–0.82, p = 0.018). Conclusions This study implies that a higher degree of participant's health education may result in the avoidance of osteoporosis risk factors. Increasing knowledge of osteoporosis should be a priority for future intervention programs in order to promote specific behavioural strategies for osteoporosis prevention.

Economic Burden of Osteoporosis-Related Fractures in Medicaid

Objectives There are limited studies concerning the economic burden of osteoporosis in the Medicaid population. This study estimated the direct cost of osteoporosis-related fractures (OPFx) to state Medicaid budgets. Methods This retrospective analysis utilized Medicaid claims databases from three states, which included approximately 8 million Medicaid recipients. The study sample had at least one claim for an osteoporosis diagnosis (733.0x) between January 1, 2000 and December 31, 2001. Beneficiaries with a fracture and a diagnosis of osteoporosis were assigned to the case cohort. A propensity score-based matching method was used to select a cohort of controls with osteoporosis but without a fracture. An exponential conditional mean model was used to estimate the incremental annual cost associated with fractures. Results The study cohort (n = 7626) and a 1:1 matched control group were identified. The study cohort was 85.8% female, had an average age of 65 years, were 53.2% white, and 48.9% were eligible for Medicare. There were significant increases (all P < 0.05) from the preperiod to study period for this cohort in the proportion that had at least one hospital admission (14.0% vs. 26.5%), nursing home admission (9.2% vs. 17.2%), home health (39.1% vs. 49.3%), or emergency room visit (21.3% vs. 31.9%). In contrast, the control cohort had very little increase in utilization. The regression-adjusted incremental cost for osteoporosis-related expenses in the year after fracture was estimated at $4007 per patient. The estimated incremental cost was $5370 for the subset of patients who were eligible for Medicare. Conclusion The economic burden of osteoporosis-related fractures on state Medicaid budgets is substantial.

Economic burden of osteoporosis, breast cancer, and cardiovascular disease among postmenopausal women in an employed population

Postmenopausal women have a significant risk of developing a number of chronic conditions including osteoporosis (OP), breast cancer (BrCa), and cardiovascular disease (CVD). These diseases can result in significant direct (medical treatment) and indirect (workplace) costs. The objective of this study is to assess these costs among an employed population. Deidentified medical and disability claims data from seven large employers (n = 585,441) were analyzed from 1998 through 2000 for female employees, age 50-64 years. Medical claim ICD-9CM codes were used to identify patients treated for: OP (n = 2,314), BrCa (n = 555), and CVD (n = 1,710). Each disease cohort was compared to a random sample of 50- to 64-year-old female employees (n = 7,575). Descriptive and multivariate techniques were used to characterize direct and indirect costs attributable to each condition. Average annual direct costs were higher (p < .001) for female employees treated for OP (6,259 dollars), BrCa (13,925 dollars), or CVD (12,055 dollars) when compared with the random sample (2,951 dollars). In addition, average annual indirect costs associated with OP (4,039 dollars), BrCa (8,236 dollars), and CVD (4,990 dollars) were higher (p < .001) than indirect costs for the random sample (2,292 dollars). Even when controlling for each disease-state cohort's demographics and disease-specific comorbidities, patients treated for OP, BrCa, and CVD continued to have significantly greater direct and indirect costs (p < .001) than the random sample. Chronic conditions such as OP, BrCa, and CVD, which occur more frequently in women after menopause, impose a significant financial burden. Greater health care utilization and work-loss prevalence among women treated for these conditions contribute to these additional costs.

Cost-effectiveness research in osteoporosis

The clinical and economic burden of osteoporosis is high and has resulted in increasing interest in assessing the costs and benefits associated with strategies to reduce the incidence of fracture. In this article, we aim to summarize the major issues related to conducting economic evaluations of therapies for osteoporosis. We identify the principal data parameters (baseline clinical probabilities, effectiveness, costs, and utilities) and economic model characteristics (patient age, compliance, and duration of therapy). We highlight these issues by referring to previous studies identified in a systematic review and to current work in the area. Further discussion provides an overview of the results of the existing economic evaluations of therapies for osteoporosis and a brief summary of ongoing research in Canada. In conclusion, there appears to be a consensus in the literature that under most circumstances hormone replacement therapy is cost-effective in the treatment of osteoporosis. Further research is required before definitive conclusions on the cost-effectiveness of other therapies can be made. Drug Dev. Res. 49:135–140, 2000. © 2000 Wiley-Liss, Inc.