COSTS AND HEALTH-EFFECTS OF OSTEOPOROTIC FRACTURES
COSTS AND HEALTH-EFFECTS OF OSTEOPOROTIC FRACTURES
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DOI：
10.1016/8756-3282(94)90813-3
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发表时间：
1994-07-01
期刊：
影响因子：
4.1
通讯作者：
WALLACE, R
中科院分区：
文献类型：
--
作者：
CHRISCHILLES, E;SHIREMAN, T;WALLACE, R
本研究的目的是估计白人绝经后妇女剩余生命中髋部、脊柱和前臂骨折的短期和长期直接医疗保健成本，并为未来成本-效果分析中估计可避免的骨折成本提供一个原型。提出了一种马尔可夫模型，该模型使用基于人群的数据和蒙特卡罗模拟来估计个体群体的终身骨折风险、骨折相关功能损伤和骨折相关成本，同时控制了功能损伤的竞争原因，从而计算了长期成本。研究模拟了5个队列，每组1万名不同年龄组的女性，以估计剩余的终生骨折、功能损伤和成本。另外的模拟测试了出院率对养老院和继续居住的影响。急性骨折护理费用、疗养院年费用、社区长期护理费用和折扣率在敏感性分析中存在差异。队列成本应用于1990年美国白人妇女的人口分布，以预测目前45岁及以上妇女的未来成本。在髋部、脊柱和前臂骨折中，根据年龄组的不同，确定髋部骨折占剩余终生骨折的36-50%。同样，髋部骨折被确定为67-79%的骨折相关依赖功能，87-100%的骨折相关养老院安置，87-96%的短期骨折费用。在45岁或以上的美国白人女性中，估计有520万髋部、脊柱和前臂骨折；200万人年的骨折相关功能损伤；预计未来10年的直接医疗费用总额将达到452亿美元。据估计，65-84岁的女性在未来10年内发生骨折的次数最多，骨折相关功能受损的人年数最多，骨折护理费用最多。估计的终身成本对骨折相关的养老院使用率的假设特别敏感。骨质疏松症的未来健康和经济影响预计将是巨大的。因为我们只包括了三个骨折部位，我们的估计可能是保守的。骨质疏松症干预可以减少对骨折相关的长期养老院护理的需求，并且对65-84岁的妇女有效，可能特别具有成本效益。
The objective of this study is to estimate the short- and long-term direct health care costs of hip, spine, and forearm fractures occurring during the remaining lifetimes of white postmenopausal women and to provide a prototype for estimating avoided costs of fractures in future cost-effectiveness analyses. A Markov model that uses population-based data and Monte Carlo simulations to estimate lifetime fracture risk, fracture-related functional impairment, and fracture-related costs for cohorts of individuals while controlling for competing causes of functional impairment and, hence, long-term costs is presented. Five cohorts of 10,000 women, each of a different age group, were simulated to obtain estimates of remaining lifetime fractures, functional impairment, and costs. Additional simulations tested the impact of discharge rates to and continued residence in nursing homes. Acute fracture care costs, nursing home annual cost, cost of community-based long-term care, and discount rates were varied in sensitivity analyses. Cohort costs were applied to the 1990 population distribution of U.S. white women to project future costs of women currently aged 45 years of age and older. Among hip, spine, and forearm fractures, hip fractures were determined to account for 36-50% of remaining lifetime fractures depending on age group of the cohort. Similarly, hip fractures were determined to account for 67-79% of fracture-related dependent functioning, 87-100% of fracture-related nursing home placement, and 87-96% of shortterm fracture costs. Among white U.S. women aged 45 or older, an estimated 5.2 million hip, spine, and forearm fractures; 2 million person-years of fracture-related functional impairment; and $45.2 billion total direct medical costs can be expected in the next 10 years. Women aged 65-84 were estimated to experience the largest number of fractures, person-years of fracture-related impaired function, and fracture care costs in the next 10 years. Estimated lifetime cost was particularly sensitive to assumptions about fracture-related nursing home utilization rates. The future health and economic impact of established osteoporosis is expected to be substantial. Because we have included only three fracture sites, our estimates are likely to be conservative. Osteoporosis interventions that can reduce the need for fracture-related extended nursing home care and that are effective among women aged 65-84 are likely to be particularly cost-effective.