il costo delle fratture da osteoporosi in italia. Risultati dello studio BloCK ( Bone Loss and Osteoporosis: Cost-of-illness Knowledge)

The objectives of the present study were to calculate the cost of illness of osteoporosis and to assess drug utilization patterns in postmenopausal women after a fracture-related hospitalization. The study subjects were enrolled from a large population-based administrative database. Female patients (age ≥ 65 years) who were hospitalized for a typical osteoporotic fracture between 1/1/2000 and 31/12/2005 were included. Patients were classified as exposed/ unexposed to treatment according to the presence/absence of at least one prescription for an osteoporosis-related medication in the 6 months following the discharge date. Treatment adherence was calculated for patients who were exposed to bisphosphonate therapy and was defined as at least 80% of treatment coverage during the followup period of 18 months after the discharge date. Hospitalizations, medications, diagnostic tests, laboratory tests and specialist visits during the 18-month follow-up period were collected and classified as osteoporosis-related or non-related to osteoporosis. A total of 12,376 patients were included in the study (mean age ± SD, 79.1 ± 7.5 years), out of which 97.9% (n = 12,110) were hospitalized due to an osteoporosis-related fracture and only 2.1% (n = 266) had general osteoporosis diagnosis. Among the 12,110 women with a fracture, 15.2% (n = 1,845) had a subsequent fracture-related hospitalization (63.8% of the patients had hip fracture). Only 32.3% (n = 4,001) of all included patients was exposed to osteoporosis-related medications and out of those patients exposed to bisphosphonates (n = 860) only 34.2% (n = 294) was adherent to therapy. The average cost per patient was € 4,481, of which € 1,089 was for osteoporosis-related and € 3,392 for non-osteoporosis-related items. The average cost of a matching cohort of patients without hospitalizations for fracture was € 2,339. Among osteoporosis-related costs, 87.0% was due to hospitalizations for subsequent fractures, 1.5% was due to subsquent hospitalizations for osteoporosis, 9.0% was due to medications, 2.5% was due to laboratory or diagnostic/ instrumental tests. Osteoporosis costs after a first hospitalization for fracture were relevant (twice the costs for patients without hospitalizations for fracture), evident in the short run (within the first 24 months following the index fracture) and mostly due to re-hospitalizations for a new typical osteoporotic fracture. This is in mainly relatedto a low exposure to pharmacological therapy and to insufficient treatment adherence. This study and publication were supported by Amgen Dompe and GlaxoSmithKline.

[1]  P. Piscitelli,et al.  [Incidence and socioeconomic burden of hip fractures in Italy]. , 2011, Reumatismo.

[2]  M. Varenna,et al.  [Adherence to treatment of osteoporosis: an open question]. , 2011, Reumatismo.

[3]  I. Santi,et al.  Fattori determinanti l'aderenza alla terapia farmacologica per l'osteoporosi e possibili strategie per migliorarla , 2010 .

[4]  Nicholas Harvey,et al.  Osteoporosis: impact on health and economics , 2010, Nature Reviews Rheumatology.

[5]  G. Lenhart,et al.  Direct healthcare costs of hip, vertebral, and non-hip, non-vertebral fractures. , 2009, Bone.

[6]  L. Masserini.  L'uso dei farmaci in Italia , 2008 .

[7]  D. Bradham,et al.  A national perspective of Medicare expenditures for elderly veterans with hip fractures. , 2008, Journal of the American Medical Directors Association.

[8]  M. Olson,et al.  Loss of treatment benefit due to low compliance with bisphosphonate therapy , 2007, Osteoporosis International.

[9]  A. Tosteson,et al.  Incidence and Economic Burden of Osteoporosis‐Related Fractures in the United States, 2005–2025 , 2007, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[10]  M. Olson,et al.  POS2 LOSS OF TREATMENT BENEFIT DUE TO LOW COMPLIANCE WITH BISPHOSPHONATE THERAPY , 2006 .

[11]  R. Herings,et al.  Persistent bisphosphonate use and the risk of osteoporotic fractures in clinical practice: a database analysis study* , 2006, Current medical research and opinion.

[12]  R. Herings,et al.  Determinants of persistence with bisphosphonates: a study in women with postmenopausal osteoporosis. , 2006, Clinical therapeutics.

[13]  J. Cramer,et al.  Compliance and persistence with bisphosphonate dosing regimens among women with postmenopausal osteoporosis* , 2005, Current medical research and opinion.

[14]  S. Boonen,et al.  Costs and consequences of hip fracture occurrence in old age: An economic perspective , 2005, Disability and rehabilitation.

[15]  C. Cooper,et al.  Health care costs of women with symptomatic vertebral fractures. , 2004, Bone.

[16]  Krista F. Huybrechts,et al.  The impact of compliance with osteoporosis therapy on fracture rates in actual practice , 2004, Osteoporosis International.

[17]  J. Rodriguez-Portales,et al.  Ten years' experience with alendronate for osteoporosis in postmenopausal women. , 2004, The New England journal of medicine.

[18]  J. Mccombs,et al.  Compliance with drug therapies for the treatment and prevention of osteoporosis. , 2003, Maturitas.

[19]  S. Cummings,et al.  Epidemiology and outcomes of osteoporotic fractures , 2002, The Lancet.

[20]  S. Boonen,et al.  The Economic Cost of Hip Fractures Among Elderly Women: A One-Year, Prospective, Observational Cohort Study with Matched-Pair Analysis , 2001, The Journal of bone and joint surgery. American volume.

[21]  J. LeLorier,et al.  Predictors of long-term persistence on statins in a subsidized clinical population. , 2000, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[22]  M. McClung.  Bisphosphonates in osteoporosis: recent clinical experience , 2000, Expert opinion on pharmacotherapy.

[23]  Jacques LeLorier,et al.  Using Healthcare Claims Data for Outcomes Research and Pharmacoeconomic Analyses , 1999, PharmacoEconomics.

[24]  C. Moran,et al.  The current hospital costs of treating hip fractures. , 2005, Injury.

[25]  S. Gabriel,et al.  Direct Medical Costs Attributable to Osteoporotic Fractures , 2002, Osteoporosis International.