An 11-year longitudinal analysis of refracture rates and public hospital service utilisation in Australia's most populous state

Abstract

This detailed 11-year longitudinal analysis calculated the public health cost of managing refractures in people aged ≥ 50 years in Australia's most populous state. It provides current and projected statewide health system costs associated with managing osteoporosis and provides a foundation to evaluate a novel statewide model of fracture prevention.

Purpose: The purpose of this longitudinal analysis was to calculate current and projected refracture rates and associated public hospital utilisation and costs in New South Wales (NSW), Australia. These results will be used to inform scaled implementation and evaluation of a statewide Osteoporotic Refracture Prevention (ORP) model of care.

Methods: Linked administrative data (inpatient admissions, outpatient attendances, Emergency Department presentations, deaths, cost) were used to calculate annual refracture rates and refracture-related service utilisation between 2007 and 2018 and healthcare costs between 2008 and 2019. Projections for the next decade were made using 'business-as-usual' modelling.

Results: Between 2007 and 2018, 388,743 people aged ≥ 50 years experienced an index fracture and 81,601 had a refracture. Refracture was more common in older people (rising from a cumulative refracture rate at 5 years of 14% in those aged 50-64 years, to 44% in those aged > 90 years), women with a major index fracture (5-year cumulative refracture rate of 26% in females, compared to 19% for males) or minimal trauma index fracture and those with an osteoporosis diagnosis (5-year cumulative refracture rate of 36% and 22%, respectively in those with and without an osteoporosis diagnosis). Refractures increased from 8774 in 2008 to 14,323 in 2018. The annual cost of refracture to NSW Health increased from AU$130 million in 2009 to AU$194 million in 2019. It is projected that, over the next decade, if nothing changes, 292,537 refracture-related hospital admissions and Emergency Department presentations and 570,000 outpatient attendances will occur, at an estimated total cost to NSW Health of AU$2.4 billion.

Conclusion: This analysis provides a detailed picture of refractures and associated projected service utilisation and costs over the next decade in Australia's most populous state. Understanding the burden of refracture provides a foundation for evaluation of a novel statewide ORP model of care to prevent refractures in people aged ≥ 50 years.

Keywords: Fracture prevention; Minimal trauma fracture; Osteoporosis; Service costs; Service utilisation.

Fig. 1

Total annual number and rate of index fractures in people aged 50 years and older residing in New South Wales over the study period 2007/2008 to 2017/2018. *New South Wales population standardised rate of index fracture

Fig. 2

Effects of age, sex and osteoporosis diagnosis on cumulative refracture rates. Panel A shows adjusted and unadjusted cumulative refracture rate over time for entire cohort; panel B shows 1-, 3- and 5-year cumulative refracture rate stratified by age; panel C shows 1-, 3- and 5-year cumulative refracture rate stratified by gender; panel D shows 1-, 3- and 5-year cumulative refracture rate stratified by diagnosis of osteoporosis

Fig. 3

Impact of refractures on past and projected health service utilisation

Fig. 4

Past and projected impact of refracture on costs for New South Wales public health services. *$ Total (dashed line) = Acute and Non-acute admissions + Emergency Department presentations. †$ Total (solid line) = Acute and Non-acute admissions + Emergency Department presentations + Non-admitted (outpatient) patient service events (data available from 2015/16). NB: In 2007–2008, both National Weighted Activity Units and costs were unavailable in the data; therefore, 2007–2008 data have not been included in the figure