The Economic Burden of Severe Osteoporotic Fractures in the French Healthcare Database: The FRACTOS Study

Abstract

Osteoporosis carries a high medical, economic, and societal burden principally because of the risk of severe fractures. The objective of this cost-of-illness study was to describe health resource utilization and associated costs in all patients aged ≥50 years hospitalized for a severe osteoporotic fracture over a 6-year period (2009 to 2014) in France. Data were extracted from the French national healthcare database (SNDS) on all health care resource utilization between the index date (date of hospitalization for first fracture during the enrollment period) and study end (December 31, 2016) or until the patient died. Costing was restricted to direct costs and determined from the payer perspective. Variables related to costs were identified through multivariate logistic regression analysis. A total of 356,895 patients were included (median follow-up 39.1 months). In the year after the index fracture, 36,622 patients (10.5%) were rehospitalized for a fracture-related reason. Only 18,474 (5.3%) underwent bone densitometry and 58,220 (16.7%) received a specific treatment. The total annual per capita osteoporosis-related cost in the year after the index severe osteoporotic fracture was €18,040 (from €8598 for multiple ribs to €21,085 for hip fracture) of which €17,905 was incurred by fracture-related costs. The cost incurred by management of osteoporosis was €135. Over years 2 to 5, the mean annual per capita costs of fracture treatment (€806, mostly attributable to the treatment of refractures) continued to dominate those of osteoporosis management (€99). Total annual cost of care was €1260 million (year 2014). Variables associated with higher cost were older age, male sex, site of fracture, a history of prior osteoporotic fracture, and the number of refracture events. The 5-year cost of severe osteoporotic fractures to the French health care system is high and mostly attributable to the treatment of refractures. Improved fracture prevention measures in patients with osteoporosis is crucial to reduce the economic burden of the disease. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Keywords: FRACTURE PREVENTION; GENERAL POPULATION STUDIES; HEALTH ECONOMICS; OSTEOPOROSIS; THERAPEUTICS.

Fig. 1

Patient flow chart. ¹Reasons for non‐eligibility are not mutually exclusive and individual patients may thus have more than one reason for exclusion. A total of 203,604 patients were not eligible for the study. The sum of the number of individual patients with a specific reason for exclusion (confounding pathology for 98,525 patients, <50 years of age for 51,716 patients, etc., as listed in the right‐hand column) is 212,715 patients. In consequence, 9111 patients (212,715 − 203,604) present more than one reason for non‐eligibility. ²History of Paget's disease, cancer, infectious arthritis, or bone fragility secondary to malignant disease or to surgical interventions. ³Covered by more than one Health Insurance Regimen during the study period. Percentages are calculated with respect to the preceding line.

Fig. 2

Variation of fracture‐related rehospitalization and osteoporosis management rates over time.

Fig. 3

Treatment persistence with first‐line specific osteoporosis treatments.

Fig. 4

Variation of cost of osteoporosis over time. Costs (y axis) are presented on a logarithmic scale for clarity because of the large variation in the different costs presented.

Fig. 5

Variables associated with the mean per capita cost of osteoporosis over the 5‐year period.