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

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An 11-year longitudinal analysis of refracture rates and public hospital service utilisation in Australia’s most populous state
Archives of Osteoporosis ( IF 3.1 ) Pub Date : 2022-05-06 , DOI: 10.1007/s11657-022-01105-w
Jennifer Williamson ₁ , Zoe Michaleff _{2,

3} , Francisco Schneuer ₄ , Peter Wong _{5,

6,

7,

8} , Christopher Needs _{9,

10} , Julia Thompson ₁₀ , Liz Hay ₁

Affiliation

Economics and Analysis Unit, Strategic Reform and Planning Branch, NSW Ministry of Health, St Leonards, New South Wales, Australia.
Institute for Evidence Based Healthcare, Faculty of Health Science and Medicine, Bond University, Robina, QLD, Australia.
Institute for Musculoskeletal Health, School of Public Health, The University of Sydney and Sydney Local Health District, Camperdown, New South Wales, Australia.
The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, Australia.
Department of Rheumatology, Westmead Hospital, Westmead, NSW, Australia.
Westmead Clinical School, Faculty of Medicine, The University of Sydney, Westmead, NSW, Australia.
Rural Medical School, Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia.
Healthy Bones Australia, Sydney, NSW, Australia.
Department of Rheumatology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
Agency for Clinical Innovation Musculoskeletal Network, St Leonards, New South Wales, Australia.

Summary

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.

中文翻译：

澳大利亚人口最多州的再骨折率和公立医院服务利用率的 11 年纵向分析

概括

这项为期 11 年的详细纵向分析计算了在澳大利亚人口最多的州管理 ≥ 50 岁人群再骨折的公共卫生成本。它提供了与管理骨质疏松症相关的当前和预计的全州卫生系统成本，并为评估新型全州骨折预防模型提供了基础。

目的

此纵向分析的目的是计算澳大利亚新南威尔士州 (NSW) 当前和预计的再骨折率以及相关的公立医院利用率和成本。这些结果将用于为全州骨质疏松再骨折预防 (ORP) 护理模型的大规模实施和评估提供信息。

方法

关联的行政数据（住院病人入院、门诊就诊、急诊科就诊、死亡、费用）用于计算 2007 年至 2018 年的年度再骨折率和再骨折相关服务利用率以及 2008 年至 2019 年的医疗保健费用。对未来十年进行了预测使用“一切照旧”模式。

结果

2007 年至 2018 年期间，388,743 名 50 岁以上的人经历了指数骨折，81,601 人再次骨折。再骨折在老年人中更为常见（5 年累积再骨折率从 50-64 岁的 14% 上升到 90 岁以上的 44%），有主要骨折指数的女性（5 年累积再骨折率女性的再骨折率为 26%，而男性为 19%）或轻微创伤指数骨折以及诊断为骨质疏松症的患者（诊断为骨质疏松症和未诊断为骨质疏松症的患者的 5 年累积再骨折率分别为 36% 和 22%） . 再骨折从 2008 年的 8774 例增加到 2018 年的 14,323 例。NSW Health 每年的再骨折成本从 2009 年的 1.3 亿澳元增加到 2019 年的 1.94 亿澳元。预计在未来十年，如果没有任何变化，292，