Summary

This study identified the costs and health-related quality of life impacts of several post-fracture multidisciplinary care pathways specific to individual skeletal site (hip, distal forearm, vertebrae, humerus). These care pathways may assist healthcare providers in allocating resources for osteoporotic fractures in more effective and cost-efficient ways.

Introduction

This micro-costing study was undertaken to provide the estimated healthcare costs of several fracture site-specific health service use pathways associated with different trajectories of health-related quality of life (HRQoL) 12-months post-fracture.

Methods

The study included 4126 adults aged ≥ 50 years with a fragility fracture (1657 hip, 681 vertebrae, 1354 distal forearm, 434 humerus) from the International Costs & Utilities Related to Osteoporotic fractures Study (ICUROS). ICUROS participants were asked to recall the frequency and duration (where applicable) of their health and community care service use at 4- and 12-month follow-up visits. Patient-level costs were identified and aggregated to determine the average cost of healthcare use related to the fracture in each care pathway (presented in Australian 2021 dollars). Mean cost differences were calculated and analysed using a one-way analysis of variance (ANOVA) and post hoc Bonferroni correction to determine any statistically significant differences.

Results

The total direct cost of fractures was estimated at $89564, $38926, $18333, and $38461AUD per patient for hip, vertebral, wrist, and humeral participants, respectively. A Kruskal–Wallis test yielded a statistically significant difference in cost values between most care pathways (p < 0.001). Of the 20 care pathways, those associated with recovery of HRQoL had lower mean costs per patient across each fracture site.

Conclusions

This study identified the costs and HRQoL impacts of several multidisciplinary care pathways for individual fracture sites based on the health service utilization of an international cohort of older adults. These care pathways may assist healthcare providers in allocating resources for fragility fractures in more effective and cost-efficient ways.

中文翻译：

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骨折后护理途径的微观成本分析：国际骨质疏松性骨折相关成本和效用研究 (ICUROS) 的结果

概括

本研究确定了特定于个体骨骼部位（臀部、前臂远端、椎骨、肱骨）的几种骨折后多学科护理途径的成本和与健康相关的生活质量影响。这些护理途径可以帮助医疗保健提供者以更有效和更具成本效益的方式为骨质疏松性骨折分配资源。

介绍

这项微观成本研究旨在提供与骨折后 12 个月的不同健康相关生活质量 (HRQoL) 轨迹相关的几种特定骨折部位的医疗服务使用途径的估计医疗成本。

方法

该研究包括来自国际骨质疏松性骨折相关成本和公用事业研究 (ICUROS) 的 4126 名 50 岁以上的脆性骨折成人（1657 髋，681 椎骨，1354 前臂远端，434 肱骨）。ICUROS 参与者被要求在 4 个月和 12 个月的随访中回忆他们使用健康和社区护理服务的频率和持续时间（如适用）。确定并汇总患者级别的成本，以确定与每个护理途径中的骨折相关的医疗保健使用的平均成本（以澳大利亚 2021 美元表示）。使用单向方差分析 (ANOVA) 和事后 Bonferroni 校正来计算和分析平均成本差异，以确定任何统计学上的显着差异。

结果

髋部、脊椎、腕部和肱骨参与者的骨折直接总成本估计分别为每位患者 89564 美元、38926 美元、18333 美元和 38461 澳元。Kruskal-Wallis 检验在大多数护理途径之间的成本值上产生了统计学上的显着差异（p  < 0.001）。在 20 种护理途径中，与 HRQoL 恢复相关的途径在每个骨折部位的每位患者平均成本较低。

结论

本研究根据国际老年人群的卫生服务利用情况，确定了针对个别骨折部位的几种多学科护理途径的成本和 HRQoL 影响。这些护理途径可以帮助医疗保健提供者以更有效和更具成本效益的方式为脆性骨折分配资源。