Incremental costs of fragility fractures: a population-based matched -cohort study from Ontario, Canada

Abstract

Using a matched cohort design, the 1-year excess cost of incident fragility fractures at any site was $26,341 per patient, with 43% of total excess costs attributed to hospitalization. The high economic burden of fractures in Ontario underscores the urgency of closing the secondary fracture prevention gap.

Introduction: This retrospective real-world observational study was conducted to document the incremental costs associated with fragility fractures in Ontario, Canada.

Methods: Patients aged >65 years with an index fragility fracture occurring between January 2011 and March 2015 were identified from administrative databases and matched 1:1 to a cohort of similar patients without a fracture. Healthcare resource utilization data were extracted from healthcare records and associated costs were calculated on a per-patient level and for the province of Ontario. Costs were presented as 2017 Canadian dollars.

Results: The eligible cohort included 115,776 patients with a fragility fracture. Of these, 101,773 patients were successfully matched 1:1 to a non-fracture cohort. Overall, hip fractures (n = 31,613) were the most common, whereas femur fractures (n = 3002) were the least common type. Hospitalization and continuing care/home care/long-term care accounted for more than 60% of 1-year direct costs, whereas 5% was attributed to medication costs. First-year costs per patient in the fracture cohort were approximately threefold higher versus the non-fracture cohort (mean $37,362 versus $11,020, respectively). The incremental first-year direct healthcare costs of fragility fractures for the province of Ontario were calculated at $724 million per year.

Conclusions: Fragility fractures were associated with a threefold increase in overall mean healthcare costs per patient compared to patients without fractures. With an aging population, there is an urgent need for improved prevention strategies for patients at high-risk of fracture to decrease the economic burden of fragility fractures on the Canadian healthcare system.

Keywords: Cost of illness; Fragility fracture; Healthcare resource utilization; Matched cohort; Osteoporosis.

Fig. 1

Mean healthcare cost per patient in first year following index fracture, by fracture site, and type of healthcare resource. CCRS, Continuing Care Reporting System; LTC, long-term care; SD, standard deviation. *Other healthcare services include emergency department visits, hospital outpatient clinic visits, physician billings, non-physician billings, and laboratory claims

Fig. 2

Mean total healthcare costs in the first year after index date for matched fracture and non-facture cohorts. Results presented as mean (SD). CCRS, Continuing Care Reporting System; LTC, long-term care. *Other healthcare services include emergency department visits, hospital outpatient clinic visits, physician billings, non-physician billings, and laboratory claims

Fig. 3

Mean annual cost per patient up to 5 years after index fracture, by healthcare resource use category. CCRS, Continuing Care Reporting System; LTC, long-term care. *Other healthcare services include emergency department visits, hospital outpatient clinic visits, physician billings, non-physician billings, and laboratory claims