National Social Security Institute Research Articles

Burden of Short Bowel Syndrome in Italy: Direct and Indirect Costs and Quality of Life

OBJECTIVE: The Short Bowel Syndrome (SBS) is the most common cause of chronic intestinal failure (CIF) due to benign disease. The prevalence in Europe was estimated about 1.4 cases per million and few information are available for Italy. Home parenteral nutrition (HPN) is the primary and lifesaving treatment for patients with CIF. The parenteral nutrition (PN) has a great impact on the quality of life (QoL) of patients and the role of the caregiver is crucial for the disease management. The aim of this study was to evaluate the economic burden of SBS in Italy and to assess the impact of the disease and the parenteral nutrition on the quality of life of patients.METHODS: The total burden of SBS in Italy was assessed both in terms of costs and QoL using different tools. A prevalence-based cost of illness (COI) model was developed to estimate direct costs (PN cost, central venous catheter insertion cost, monitoring cost, hospitalization cost) and indirect costs (absenteeism, presenteeism, unemployment, abandonment of work due to the disease and economic benefits granted by the National Social Security Institute) associated with patient with SBS in Italy. The total annual costs were calculated considering a micro-costing approach, thus associating the average costs per patient with the prevalence of the disease. A systematic literature review (SLR) was conducted to collect epidemiological and direct cost data related to the patients with SBS. Hospital costs were estimated using the national Hospital Information System. Indirect costs were estimated using a human capital approach; therefore, the productivity loss was estimated both for patients and caregivers. A survey was conducted to obtain data about productivity loss and quality of life of patients and caregivers. The questionnaires were completed by clinicians, who were asked to indirectly report the experience of patients with SBS in parenteral nutrition currently being treated at their referral center. In a subsequent phase, a focus group was conducted to collect further information on QoL for patients and caregivers based on the experience of the KOLs involved. The QoL was evaluated considering a Likert scale.RESULTS: The prevalence of patients with gastrointestinal disease in HPN was estimated equal to 9.4 and 2.3 patients per million inhabitants for adults (age >18) and pediatric (age 0-18 years) patients, respectively. Knowing that SBS is the main cause of CIF due to benign disease, constituting 75% among adults and 56% among children, the number of adults with SBS in HPN present in Italy were 420, while the number of children with SBS in HPN were 77. Regarding direct costs, the mean total annual cost associated with adult and pediatric patient with SBS in Italy was estimated equal to € 36,434 and € 46,682, respectively. Parenteral nutrition accounted for 91% of the mean total cost estimated for the adult and for 87% of the mean total cost estimated for pediatric patient. Concerning indirect costs, the mean total annual cost per adult patient was estimated equal to € 51,093 (81% related to the productivity loss because of the abandonment of work due to the disease), while the mean total cost per pediatric patient was estimated equal to € 3,201 (60% related to caregiver’s presenteeism and 40% attributable to caregiver’s absenteeism). Finally, the average total annual cost per adult SBS patient in Italy was estimated at € 87,527 (42% of direct costs and 58% of indirect costs), whereas for pediatric patients it was estimated at € 49,882 (94% of direct costs and 6% of indirect costs). Overall, the weighted average cost for an SBS patient in Italy was estimated at € 81,712 (47% of direct costs and 53% of indirect costs). The analysis conducted on the QoL of patients with SBS in PN has shown that QoL was perceived as low (mean value equal to 5). The greatest impact on QoL was due to the disease (mean value equal to 9), while PN appeared to have less impact (mean value equal to 6).CONCLUSIONS: The analysis provides an estimate of the total burden associated with patients with SBS in Italy both in terms of cost and QoL. The cost associated with parenteral nutrition and indirect costs represent the main drivers of the total cost estimated for a patient with SBS in Italy. Based on the experience of the KOL involved in this study it was also found that the disease has a great impact on the QoL of these patients.

Benefícios acidentários e previdenciários concedidos a portadores de câncer no Brasil, 2008-2014

Abstract This article aims to describe the distribution of cancer among the benefits granted by the General Social Security Registry, from 2008 to 2014, in Brazil. Ecological study using data given by the National Social Security Institute. The proportion of accidental (work-related) and social security (general) benefits granted by cancer in Brazil was determined, among the benefits granted for all causes, and a spatial analysis was conducted to assess the geographical distribution of these proportions, with the states Brazilians as a unit of analysis. Cancer was the reason for granting 533,438 benefits (2.9% of the total benefits granted for all causes), with a predominance of females in social security benefits (53.7%) and males in accidental benefits (71.6 %). The highest proportions of social security benefits for cancer occurred in North and Midwest regions. In 19 of the 26 Brazilian states (including all states in the southern region) and in the Federal District, there was no granting of accident benefits for cancer. The analysis of the occurrences of cancer that generated benefit concessions suggests a disproportionality in granting of social security benefits in relation to accident workers, mainly in North, Northeast and South regions of Brazil.

Accident and social security benefits granted to cancer patients in Brazil, 2008-2014

This article aims to describe the distribution of cancer among the benefits granted by the General Social Security Registry, from 2008 to 2014, in Brazil. Ecological study using data given by the National Social Security Institute. The proportion of accidental (work-related) and social security (general) benefits granted by cancer in Brazil was determined, among the benefits granted for all causes, and a spatial analysis was conducted to assess the geographical distribution of these proportions, with the states Brazilians as a unit of analysis. Cancer was the reason for granting 533,438 benefits (2.9% of the total benefits granted for all causes), with a predominance of females in social security benefits (53.7%) and males in accidental benefits (71.6 %). The highest proportions of social security benefits for cancer occurred in North and Midwest regions. In 19 of the 26 Brazilian states (including all states in the southern region) and in the Federal District, there was no granting of accident benefits for cancer. The analysis of the occurrences of cancer that generated benefit concessions suggests a disproportionality in granting of social security benefits in relation to accident workers, mainly in North, Northeast and South regions of Brazil.

Economic burden of depression in Brazil: a cost-of-illness study based on productivity losses and healthcare costs between 2010 to 2018

ABSTRACT Background Depression is disabling disorder and cause functional impairments, and high costs for the health and social security system. Objective The direct and indirect costs of depression from the societal perspective were estimated for the period 2010 to 2018. Methods This cost-of-illness study in adults is based on prevalence, with a top-down approach, from the societal perspective. Direct (hospital and outpatient) and indirect (absenteeism) costs were included. Data were extracted from the Hospital and Outpatient Information Systems and the National Social Security Institute. Results The cost of depression was Int$ 2,288,511,607.39 in the analyzed period, with an average annual cost of Int$ 254,279,067.49. From 2014 to 2018, had a sharp and persistent decrease in the cost of depression (−44.24%), mainly in indirect costs (−55.83%). In the period investigated, indirect costs represented 74.85% of the total cost. Over time, outpatient surpassed hospital cost. In 2017 and 2018, outpatient costs represented 43.22% and 39.57% of total costs. In all the years and cost components analyzed, women predominated. Conclusions Depression is a disease with a high economic burden for the healthcare system. Investments are still needed, such as higher coverage of services, multidisciplinary teams, and training of health professionals for psychosocial care.

The Assessment of Disability in Italy: The Laborious Procedure and Sharing of Objectives.

The assessment of disability in Italy requires the support of a system entirely dedicated to forensic evaluative medicine, which, for years, has been associated with the National Social Security Institute (INPS). Its medical offices are daily engaged in evaluating applications submitted by citizens. Their examination takes place in two different ways in the various Italian regions: assessments carried out by the Local Health Authority (ASL) and controlled by the INPS; evaluations carried out entirely by the INPS only. The main problem observed, and not yet resolved, is the excess time taken to respond to a citizen's request, especially in areas where the procedure retains the biphasic ASL-INPS modality. This phenomenon is exemplified by the presentation of cases of the INPS medical office of Iglesias (South Sardinia, Italy), which include a series of disability applications examined in the year 2021 from January to September. The most favourable feedback is a tested and shared path in the determination of judgments.

Temporal trends in social security benefits for female breast cancer in Brazil.

The aim of this study was to assess temporal trends in disability benefits for breast cancer awarded to women by Brazil's National Social Security Institute. We conducted a time-series analysis of disability benefit incidence rates between 2007 and 2018 using joinpoint regression and data from the Unified Benefits Information System (SUIBE) and open access social security system database. The age-adjusted incidence rate increased by 6.7% per year between 2015 and 2018 after a period of stability between 2007 and 2014. The number of benefits granted to women aged 20-49 increased, on average, by 3.4% per year, showing a marked rise from 2015 to 2018 (10.4% per year). The findings highlight that breast cancer is an important cause of sick leave among female workers and that the incidence of the disease is growing in younger economically active women, reinforcing the importance of early referral to the Social Security Professional Rehabilitation Program to help workers return to work and readapt to working life.

Tendência temporal dos benefícios previdenciários concedidos por câncer de mama feminino no Brasil

Abstract The aim of this study was to assess temporal trends in disability benefits for breast cancer awarded to women by Brazil’s National Social Security Institute. We conducted a time-series analysis of disability benefit incidence rates between 2007 and 2018 using joinpoint regression and data from the Unified Benefits Information System (SUIBE) and open access social security system database. The age-adjusted incidence rate increased by 6.7% per year between 2015 and 2018 after a period of stability between 2007 and 2014. The number of benefits granted to women aged 20-49 increased, on average, by 3.4% per year, showing a marked rise from 2015 to 2018 (10.4% per year). The findings highlight that breast cancer is an important cause of sick leave among female workers and that the incidence of the disease is growing in younger economically active women, reinforcing the importance of early referral to the Social Security Professional Rehabilitation Program to help workers return to work and readapt to working life.

Impactos da insuficiência cardíaca no sistema de saúde e previdenciário brasileiro: qual é o custo da doença?

Objetivo: Estimar os principais custos indiretos da insuficiência cardíaca (IC) na população brasileira, sobre o sistema de saúde, o custo previdenciário e o quanto se perde em produtividade pelas complicações da doença. Métodos: Estudo ecológico desenvolvido com dados secundários, para a série histórica de 2018 a 2021, minerados do Departamento de Informática do Sistema Único de Saúde (Datasus), do Instituto Brasileiro de Geografia e Estatística (IBGE), e indicadores previdenciários coletados da Previdência Social e Instituto Nacional do Seguro Social (INSS). Resultados: Foram registrados 77.290 óbitos por IC no Brasil para o período, distribuídos uniformemente em relação ao sexo. A taxa de mortalidade foi diversificada entre as regiões brasileiras, com ênfase para Sudeste e Nordeste. As projeções indicam um gasto total de mais de R$ 1 bilhão com hospitalizações, com custo médio hospitalar de R$ 1.725,27 por pessoa. O custo médio por internação ultrapassou os R$ 2 bilhões de reais. Aproximadamente 3% das despesas federais são destinadas a pagamentos de benefícios relacionados a IC. Do total de afastamentos, 65% correspondem a homens e 35%, a mulheres, com custos que podem chegar a R$ 6 bilhões perdidos por ano. Conclusão: Os resultados sugerem um aumento do afastamento de portadores de IC da força de trabalho, o que acarreta maiores dispêndios para o sistema de saúde e pagamentos de benefícios previdenciários, como auxílio-doença e aposentadoria por incapacidade de longa duração. Este é o primeiro estudo que estima e correlaciona os dados socioepidemiológicos e os custos de saúde e previdenciários da IC no Brasil.

Mortality rate of high cardiovascular risk patients with mild cognitive impairment

People with mild cognitive impairment (MCI) may be at higher risk of death than normal aging ones. On the other hand, patients with cardiovascular risk factors are also with higher risk of death. It may be logical to question then if the combination of MCI and cardio-vascular risk factors (in most cases arterial hypertension) can lead to higher mortality rate than expected both for high cardio-vascular risk patients and for the general population. This hypothesis is important in the light of effective early screening and prophylaxis. The general death rate of patients with very high-cardio-vascular-risk was compared in the subgroups of normal cognition and MCI. We used MMSE and MoCA (reassessment 6 months apart), Geriatric Depression scale and 4-point version of the scale for evaluating the performance in instrumental activities of daily living (4-IADL) in 249 patients. The patients also had laboratory testing, ambulatory blood pressure monitoring, ECG and echocardiography. The general mortality rate of this very high cardio-vascular risk group was assessed 8–10 years afterwards and also compared to the general national death rate published for the corresponding period from the National Social Security Institute of Bulgaria. We registered significantly higher general death rate in patients with MCI and very high cardio-vascular risk as compared to the group without MCI. The logistic regression analysis attributed approximately 14.6% of the mortality rate in this high-risk group to MCI. The major cardio-vascular risk factor was arterial hypertension—with 63.85% of the patients with home blood pressure values not in the target range at the initial cognitive screening. During the neuropsychological reevaluation 56.43% were with poor control despite the multidrug antihypertensive regimen. It is known that MCI is correlated with cardiovascular risk factors with the leading role of arterial hypertension. We found that the combination of MCI and arterial hypertension can lead to higher mortality rate than in the general aging population. This has important clinical implications for the everyday practice.

Profile of workers receiving disability benefits for depressive conditions in south Santa Catarina, Brazil.

IntroductionIn recent years, mental disorders have remained the third leading cause of sick-pay benefits due to incapacity for work in Brazil.ObjectivesTo assess the profile and outcomes of workers receiving sick pay for depression through the Criciúma unit of the Brazilian National Social Security Institute (Instituto Nacional do Seguro Social, INSS).MethodsThe study was carried out using data obtained from the Electronic System Portal of the INSS Citizen Information Service of Criciúma, state of Santa Catarina. A total of 343 individuals were selected over a 1-year period. We then analyzed all new benefits granted over a 6-year period.ResultsMild depressive episode was the disorder that prompted the most disability benefits. The mean age was 42 years, with a predominance of female beneficiaries. Overall, 56% of beneficiaries were granted at least one new disability benefit. Mental health disorders were among the leading causes. The duration of new benefits was significantly longer.ConclusionsThe typical profile is that of a 42-year-old woman, gainfully employed, earning one to two times the minimum wage, with low educational attainment, who is deemed unfit for work due to a mild depressive episode. Older age was a risk factor for being awarded a new benefit. Benefits classified as due to a more serious condition and those awarded subsequent to the first benefit had a longer duration. Given the relevance of depression to occupational health, we hope that the findings of the present study will contribute to the literature and encourage new research in the field.

Monitoring the trend of occupational injuries: comparison between different indicators

to compare three injuries indicators to establish which are less affected by underreporting and therefore best suited for the monitoring of the occupational injuries time trend during economic crisis. open cohort. a national sample of employees in the private sector, blue collars, males aged 15-64 years, extracted from the Work History Italian Panel-Healt archive, which combines data about firms and employee from the National Social Security Institute (Inps) and occupational injuries data from the Italian National Institute for Insurance against Accidents at Work (Inail). annual injuries rates for the period 2001-2012 classified according to three severity definitions: • serious injuries according to the prognosis (IGP); • serious Injuries according to the type of lesion (IGL); • minor injuries. Time trends and their changes during the economic crisis (2008-2013) were analysed through negative binomial regression models, stratified by country of origin, macroarea of work, firm size, and economic activity. IGP rates decreased more than IGL and minor injuries rates during the economic crisis, highlighting their greater association with the economic cycle. Negatives and significant trend changes were observed in some subgroups: in manufacturing, among workers from high developed countries and Moroccans, in the Northern and Central macroareas of Italy, and in larger firms. variations in injuries rates were not so much influenced by the underreporting of injuries as by the changes in the working conditions following the economic crisis. To accurately monitor the injuries time trends, it is recommended to report at the same time at least one indicator based on minor injuries and one based on serious injuries.

JUDICIALIZAÇÃO DOS REQUERIMENTOS DE SALÁRIO MATERNIDADE DECAÍDOS EM DECORRÊNCIA DA MP871/2019

In this article we will discuss the judicialization of maternity wage requirements that fell due to MP871 / 2019. The adopted methodology is an applied, descriptive research, treating the subject in a quantitative way, through field research, news sites, articles, theses, statistical data from the National Social Security Institute (INSS) and other ways. Therefore, this article aims to analyze the judicialization of the cases reached by the amendment intended by Provisional Measure 871/2019, with regard to reducing the decadential term from 5 (five) years to 180 (one hundred and eighty) days for require the maternity wage, which is due to mothers after childbirth or adoption. In view of this, we can see how the reflexes of the aforementioned Provisional Measure have been of great importance and should be discussed, since at the time it causes damage it shows a setback in society.

O CRITÉRIO DA BAIXA RENDA NA CONCESSÃO DO BENEFÍCIO ASSISTENCIAL À PESSOA IDOSA OU DEFICIENTE

The theme is based mainly on the reality of many Brazilians who are not insured by the INSS (National Social Security Institute) who have some kind of disability or even reached the minimum age to retire. The purpose is to show the reality of many people who are unable to become insured and who depend on making their rights impossible. It deals with the Brazilian social assistance contained in article 203 of the Federal Constitution of 1988, with regard to the distribution of the value of income per capita of the minimum wage and shows that regardless of the situation of each family, there is a great discussion about this regularization in the our legal system. In this sense, the general objective of this study is related to the act of granting better living conditions to beneficiaries who have low income, through the application of the Organic Law on Social Assistance. In addition, the Continuous Payment Benefit will consist of a series of actions, measures designed to meet basic human needs, guaranteeing minimum social conditions for the necessary configuration of a dignified life, and providing health and protection (social security or social security) to prevent misfortunes caused by not working. Therefore, BPC (Continuing Benefit) found its identity in basic protection, as it aims to ensure that beneficiaries enjoy the right to family and community coexistence and social work with their families, contributing to meeting their needs and development your skills and competences.

An Analysis of the Social and Economic Costs of Breast Cancer in Italy.

Background: Breast cancer is the most prevalent cancer affecting women and it represents an important economic burden. The aim of this study was to estimate the socio-economic burden of breast cancer (BC) in Italy both from the National Health Service (NHS) and the government perspectives (costs borne by the social security system). Methods: The economic analysis was based on the costs incurred by the NHS from 2008 to 2016 (direct costs related to hospitalizations) and by the National Social Security Institute (INPS) from 2009 to 2015 (costs of social security benefits) for patients with breast cancer. The analysis was based on the Hospital Information System (HIS) and Disability Insurance Awards databases. For both databases, patients affected by a malignant neoplasm of the female breast, carcinoma in situ, or secondary malignant neoplasm of the breast were considered. Results: Results show that more than 75,000 women were hospitalized for breast cancer every year, with an overall cost for hospitalization of about €300 million per year. From the Social Security analysis, a number of 29,000 beneficiaries each year was estimated. Considering per patient social costs, breast cancer at the primary stage cost €8828 per year, while secondary neoplasms cost €9780, with an average total economic burden of €257 million per year. Conclusions: This analysis focused on the economic impact of breast cancer in Italy, showing that an advanced stage of the disease was associated with a higher cost.

Analysis of factors related to granting sickness benefits to industry workers on leave due to Work-related Musculoskeletal Disorders (WMSD)

Background: Sickness absence represents a serious problem for industry and Social Security, since many of these workers become beneficiaries by the National Social Security Institute. The relationship between the factors that lead to dismissal and granting benefits to workers in the industry has yet to be studied. Objective: To determine the relationship between social and occupational factors to granting sickness benefits to industrial workers affected by Work-related Musculoskeletal Disorders. Methods: This is a retrospective cross-sectional with quantitative approach study involving industrial workers. The data contained in the evaluation form of workers who were admitted between 2016 and 2020 in a Reference Centers in Occupational Health were used. The data were descriptively evaluated and a logistic regression model was used to estimate the factors which are related to the type of assistance granted to the workers. Results: 108 medical records of industry workers were evaluated and 56.5% received the accident-related sickness assistance benefit (B-91). Most are workers from industry with light demand (95.4%), who perform repetitive work (93.5%), intense work pace (83.3%), with the shoulder being the region most frequently affected (85.2%). The factors that were significantly related to grating accidental-related sickness benefit: time in the current occupation (OR = 1.01), work involving cervical spine flexion (OR = 4.68), participation in the rehabilitation program (OR = 31.27) and referral to specialist consultations (OR = 3.10). Conclusion: The creation of institutional programs in the industry and the implementation of public health and social security policies are necessary to manage these factors.

METODOLOGIA PARA A AVALIAÇÃO DA QUALIDADE NO SERVIÇO PÚBLICO: UMA APLICAÇÃO EM UMA AGÊNCIA DO INSS

Goal: This paper aims to present a simplified methodology for evaluating the quality of public service through the case of an agency of the National Social Security Institute located in Belém do Pará. Design½Methodology½Approach: The method presented is guided by quality criteria: speed of service, perceptible aspects, communication, access, service, and flexibility; measured on a Likert scale, rated from 1 to 5, presented in two ranges for each criterion, the first range corresponding to the importance and the second to satisfaction. It also comprises open-ended support questions. Results: The results showed that the method is useful to clarify the importance attributed to each quality criterion by users, as well as their satisfaction with the provision of service. From a practical point of view, it was found that the satisfaction of attendants with the service is lower than that of users with the same service. Results particular to the case studied are presented. Originality½Value: The absence of an accessible tool to verify users' perception of the quality of public service motivates this research. The method is ready to be used and tested, as well as customized for each type of customer service in public organizations.

Relation between cumulative damage in systemic lupus erythematosus and recognised disability by the National Social Security Institute of Spain (INSS)

IntroductionSystemic Lupus Erythematosus (SLE) is a multisystemic autoimmune disease that particularly affects young women during their second and third decades. Events attributed to SLE itself and others related to the disease may impact negatively on the quality of life, employment and disability. However, there are not many studies focused on the impact that the disease may have on patients regarding those aspects. In Spain, the evaluation of disability and the assignation of a pension is given by the National Social Security Institute of Spain, INSS (“Instituto Nacional de la Seguridad Social”). ObjectiveTo assess the relationship between cumulative damage regarding the affected organ and the percentage of disability recognised by the National Social Security Institute of Spain (INSS) in SLE patients. MethodsCross-sectional prospective study of SLE patients according to the SLICC-2012 criteria, from the Rheumatology Service of two Spanish hospitals. We collected clinical and demographic data through personal interview and the SLICC/ACR questionnaire, and classified patients regarding a recognised disability or not. Results142 patients were evaluated; 30% had some percentage of official disability. We found a positive correlation between percentage of recognised disability and the SLICC/ACR index score. Musculoskeletal system is the most affected system, without differences between both groups; but we found a higher proportion of damage in nervous system, renal and vasculitis in patients with a recognised disability. ConclusionThere is a positive correlation between percentage of recognised disability in Spain and the cumulative damage in SLE.

O trabalho do (a) Assistente Social no INSS: contribuições para a saúde do trabalhador a partir da reabilitação profissional

Este artigo analisa o trabalho do (a) Assistente Social no Instituto Nacional do Seguro Social (INSS) e sua contribuição para a garantia do direito à Saúde do Trabalhador, a partir da Reabilitação Profissional. O estudo é de natureza qualitativa com caráter exploratório. A investigação ocorreu em três Gerências Executivas do INSS, do sul do país, com Assistentes Sociais que atuam no Serviço Previdenciário de Serviço Social. Como resultado se encontrou desafios importantes para o trabalho profissional no âmbito da Saúde do Trabalhador e no reconhecimento do seu objeto de trabalho. Fica evidente seu papel na articulação intrainstitucional e intersetorial e nos mecanismos de legitimação do Serviço Social nessa área. Conclui-se que há importante contribuição profissional para a Saúde do Trabalhador e a Proteção Social, a partir da Reabilitação Profissional mesmo diante dos desafios históricos desse serviço.

Los cambios en la gestión del régimen de clases pasivas: ¿un ataque a las singularidades de los regímenes especiales de funcionarios?

El objetivo de este trabajo es analizar los cambios en la gestión del régimen de clases pasivas aprobados durante el 2020 dentro de la legislación de urgencia suscrita durante el estado de alarma. El traspaso de la gestión al Instituto Nacional de Seguridad Social plantea tres cuestiones: primero, si el traspaso es técnicamente adecuado; segundo, por qué se ha efectuado en un real decreto ley de medidas para paliar los efectos económicos del COVID-19 una medida que afecta a la gestión de las pensiones de funcionarios, y, tercero, qué puede suponer este cambio de gestión para las especialidades contenidas en este régimen especial.

Osteoporosis: Economic Burden of Disease in Italy.

Today, osteoporosis is the most common bone disease and an important public health problem in all developed countries. The objective of this study was to estimate the costs associated with the management and treatment of osteoporosis in order to assess the economic burden in Italy for 2017, in terms of direct medical costs and social security costs. A cost of illness model was developed to estimate the average cost per year sustained by the NHS (National Health Service) and Social Security System in Italy. A systematic literature review was performed to obtain epidemiological, direct and indirect costs parameters where available. Hospitalisation costs were calculated considering the administrative database of the hospital discharge records for the period 2008-2016. Patients were enrolled in the analysis if they report the subsequent inclusion criteria: age ≥ 45years and presence of osteoporosis in primary or secondary diagnosis (ICD9-CM 733.0) and/or presence of a major fracture in primary or secondary diagnosis (excluding road accidents) in the following locations: spine (codes ICD9-CM: 805;806), femur (codes ICD9-CM: 820; 821), radius and ulna (codes ICD9-CM: 813.4; 813.5), humerus (codes ICD9-CM: 812.0-812.5), pelvis (code ICD9-CM: 808), tibia and fibula (codes ICD9-CM: 823), ankle (code ICD9: 824) and ribs (codes ICD9-CM: 807.0; 807.1). Costs were estimated considering the diagnosis-related group (DRG) national tariff associated with each hospitalisation. Finally, the administrative databases of the Italian National Social Security Institute (INPS) (2009-2015) were analysed for the estimate the pension and disability costs from the social perspective. The model estimated an average annual economic burden of osteoporosis in Italy of €2.2 billion. Of this cost, approximately 80% (€1.8 billion) was associated with hospitalisations, 16% (€351 million) for pharmacological treatments, 3% (€71 million) for ambulatory visits, and 0.6% (€13 million) for social security costs. The average yearly cost per patient was equal to €8691 (€8591 for hospitalisations). Analysing severe patients, hospitalisation costs increase to €12,336 (+ 44% if compared to non-severe osteoporosis patients). The analysis showed that osteoporosis represents one of the main health problems in Italy and the ability to maintain patients in a non-severe health state could decrease the economic burden from both NHS and social perspective.