Economic Burden of Osteoporotic Patients with Fracture: Effect of Treatment With or Without Calcium/Vitamin D Supplements

Abstract

Background:

Fractures represent the most important complication of osteoporosis, in terms of loss of independency, chronic pain, increased risk of mortality, but also high healthcare costs.

Objective:

To assess healthcare costs in an Italian cohort of osteoporotic patients with a fracture with and without specific osteoporosis treatment and supplementation with calcium/vitamin D.

Methods:

This retrospective observational study used data from administrative databases of five Local Health Units in Italy. Patients ≥50 years of age and hospitalized for vertebral or hip fracture occurring from 01/01/2011 to 31/12/2015 were included. Patients were then classified as “untreated” and “treated” if they had been treated or not with drugs for fracture prevention after the index fracture. We also identified subjects that were only treated with drugs for fracture prevention, “osteoporosis drug only” group, compared to the “osteoporosis drug plus calcium/vitamin D” group, in which calcium and/or vitamin D were also in combination. Healthcare cost analysis included drug expenditure, hospitalization costs (excluding costs related to the hospitalization for the index fracture) and outpatient service costs.

Results:

Three thousand four hundred and seventy-five patients were included in the present study, most of whom (58.5%) had received specific osteoporosis treatment after index fracture. Among treated patients, the vast majority (83.6%) received supplementation with calcium/vitamin D. Mean annual healthcare cost per patient was €9,289.85 in the untreated group and €4,428.26 for treated subjects (p < 0.001); mean annual healthcare cost for the osteoporosis drug-only group was higher compared to the osteoporosis drug plus calcium/vitamin D group (€5,976.88 vs €4,124.74, respectively, p < 0.001). Hospitalization costs accounted for the majority of total costs in all groups of patients.

Conclusion:

Healthcare costs in patients with osteoporotic fractures were significantly lower in those receiving osteoporosis treatment compared to untreated patients with even lower costs observed in patients that were also receiving calcium/vitamin D supplements.

Keywords:

• healthcare costs
• calcium/vitamin D supplementation
• osteoporosis
• fracture
• hospitalization

Abbreviations

CCI, Charlson Comorbidity Index; CI, Confidence interval; DB, Databases; DRG, Diagnosis-related group; ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification; LHU, Local Health Unit; MPR, Medication Possession Ratio; NHS, National Health System; SD, Standard deviation.

Ethics Approval and Informed Consent

According to Italian law,²⁵ this study has been notified to the local Ethics Committee of the LHU involved in the study. Informed consent was not required as we used encrypted retrospective information.

Data Sharing Statement

Data are not available due to ethical issues.

Acknowledgments

We would like to thank all participants who took part in this study. This study was conducted on behalf of A Vercellone and E Nava (Department of Pharmacy, Local Health Unit Naples 3 South, Italy); F Ferrante, C Bianchi, S Crescenzi, P Filomena, M Folcatrelli (Department Diagnostic and Pharmacy - U.O.C. Pharmacy – Local Health Unit Frosinone, Italy); A Constantini (Hospital Pharmacy, “Spirito Santo Hospital”, Pescara, Italy); C Cattaruzzi (Pharmaceutical Care Unit, ASUIUD, Udine, Italy).

Funding

This study was sponsored unconditionally by Abiogen Pharma S.p.A, Pisa, Italy.

Author contributions

All authors contributed to data analysis, drafting and revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.