Elsevier

Bone

Volume 40, Issue 6, June 2007, Pages 1602-1609
Bone

The societal burden of osteoporosis in Sweden

https://doi.org/10.1016/j.bone.2007.02.027Get rights and content

Abstract

In osteoporosis, the bone mass is decreased, thereby increasing the risk of fractures. Common osteoporotic fractures include those at the hip, the spine and the forearm. Fractures are a burden to society; in terms of costs, morbidity and mortality. The main objective of this study was to estimate the burden of osteoporosis in Sweden. The study used a prevalence-based bottom-up approach to estimate the total annual burden of osteoporosis in Sweden. The burden was assessed from a societal perspective including medical care costs, non-medical care costs, informal care and indirect costs. Moreover, the value of quality-adjusted life-years (QALYs) lost because of fractures was included in the total burden estimations.

The total annual fracture cost was estimated at MSEK 5639, which is about 3.2% of the total health care costs in Sweden. Community care was the most important cost category accounting for 66% of the total annual cost followed by medical care costs (31%), informal care (2%) and indirect costs (1%). By combining the annual value of QALYs lost (MSEK 10 354) and the annual fracture costs, the total annual societal burden of osteoporosis in Sweden was estimated at MSEK 15 183. Assuming no changes in the age-differentiated fracture risk, the annual burden of osteoporosis was projected to increase to MSEK 26 301 in the year 2050.

The present study shows the societal burden of osteoporosis in Sweden to be higher than previously perceived. This burden is substantial and must be acknowledged as an important health problem. Osteoporosis-related fractures do not only lead to high medical care costs but also to high community care costs.

Introduction

In osteoporosis, the bone mass is decreased, thereby increasing the risk of fractures. Common osteoporotic fractures include those at the hip, the spine and the forearm [1] and most attention has been directed towards hip fracture because of its high costs, morbidity and mortality [2]. More recently, it has also become clear that the burden of vertebral fracture has been underestimated [3]. Osteoporosis, which is manifested as fractures, is a growing health concern in the Western world. The increase in the number of fractures during the last decades, and the development of technologies for prevention and treatment, has also made osteoporosis a growing economic issue [4]. A form of health economic study is the cost-of-illness study which estimates the costs related to a specific disease. A cost-of-illness study gives no direct guidance of how resources should be allocated to improve efficiency, but could give information about the total societal burden which can be important when determining what attention and awareness the disease should be given in, for example, public health interventions. Another important aspect is that cost-of-illness studies could also provide information about who (e.g., the health care sector or the individual) bears the burden of disease.

A previous cost-of-illness study has estimated the annual cost of osteoporosis in Sweden to SEK 3.5 billion [5]. However, this study only considered acute fracture-related health care costs. The actual burden of osteoporosis is probably higher than this estimate, because fractures are also related to costs beyond the acute phase. Moreover, the loss in morbidity and mortality related to fractures should also be considered when assessing the societal burden of a disease.

The objective of this study was to assess the annual societal burden of osteoporosis in Sweden.

Section snippets

Cost of illness methodology

The burden of osteoporosis was estimated using a prevalence-based bottom-up approach [6]. In short, the method is about multiplying the number of cases within a defined period of time with the corresponding disease-related cost.

Costs

The present study had a societal perspective, which means that all costs related to the disease should be included, regardless of who incurs them. Costs that should be included in a study with a societal perspective are direct costs (medical and non-medical), informal

Acute fracture costs

The annual acute fracture-related costs in Sweden were estimated at MSEK 3497 (see Table 2). The main cost category is medical care costs (i.e., inpatient care, outpatient care and pharmaceuticals) with 58% of the acute fracture costs followed by community care with 38%. About 5% of the acute fracture costs can be related to indirect costs and informal care. 27% of the costs are related to male fractures, which is because two thirds of all osteoporotic fractures occur in women. Hip fractures

Discussion

In this study, the annual societal burden of osteoporosis in Sweden has been estimated for the first time. A previous study has estimated the annual cost of osteoporosis in Sweden at SEK 3.5 billion [5]. These estimates only included costs related to the first year after fracture and were calculated by multiplying the number of incident fracture cases with a unit cost and were thus somewhat less sophisticated than the calculation of the same figure in this study. However, the estimate is more

References (51)

  • M. Drummond et al.

    Methods for the economic evaluation of health care programmes

    (1997)
  • Statistics Sweden. Sweden's statistical databases, http://www.scb.se/eng/databaser/ssdasp. Available from:...
  • F. Borgstrom et al.

    Costs and quality of life associated with osteoporosis-related fractures in Sweden

    Osteoporos. Int.

    (2005)
  • N. Zethraeus et al.

    Estimating the costs of hip fracture and potential savings

    Int. J. Technol. Assess. Health Care

    (1998)
  • N. Zethraeus et al.

    The cost of a hip fracture. Estimates for 1,709 patients in Sweden

    Acta Orthop. Scand.

    (1997)
  • Swedish National Inpatient Register and Causes of Death Register, The Swedish National Board of Health Centre — The...
  • J.A. Kanis et al.

    Long-term risk of osteoporotic fracture in Malmö

    Osteoporos. Int.

    (2000)
  • J.A. Cauley et al.

    Risk of mortality following clinical fractures

    Osteoporos. Int.

    (2000)
  • C. Cooper et al.

    Population-based study of survival after osteoporotic fractures

    Am. J. Epidemiol.

    (1993)
  • T. Jalava et al.

    Association between vertebral fracture and increased mortality in osteoporotic patients

    J. Bone Miner. Res.

    (2003)
  • J.A. Kanis et al.

    Excess mortality after hospitalisation for vertebral fracture

    Osteoporos. Int.

    (2004)
  • A. Oden et al.

    Lifetime risk of hip fractures is underestimated

    Osteoporos. Int.

    (1998)
  • O. Johnell et al.

    Mortality after osteoporotic fractures

    Osteoporos. Int.

    (2004)
  • N. Zethraeus et al.

    Models for assessing the cost-effectiveness of the treatment and prevention of osteoporosis

    Osteoporos. Int.

    (2002)
  • B. Jonsson et al.

    Cost-effectiveness of fracture prevention in established osteoporosis

    Scand. J. Rheumatol., Suppl.

    (1996)
  • Cited by (0)

    View full text