The societal burden of osteoporosis in Sweden
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
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