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Hospital Admissions and Inpatient Costs of Non-Union, Delayed Union and Mal-Union Following Long Bone Fracture
A916
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 8 0 7 – A 9 1 8
associated with a higher risk of subsequent fractures. Conclusions: Subsequent fractures after an initial osteoporotic fracture bring significant healthcare burden in China. Identification of patients at a high risk of subsequent fractures and efforts on reducing their risk are needed. PMS6 Burden of osteoporosis-related hip fracture in asia. A review of health care costs and resource utilization Mohd Tahir NA1, Thomas P2, Li SC1 of Newcastle, Callaghan, NSW, Australia, 2Taylor’s University, Selangor, Malaysia
1University
Objectives: Osteoporotic fractures, especially hip fractures, impose large direct and indirect healthcare costs to the government and societies. The objective of this review was to systematically analyse available evidence on healthcare costs associated with osteoporosis-related hip fractures in Asia. Methods: Articles were systematically searched from databases including PubMed, EMBASE, Medline, and EBSCOHost between 2000 and 2015. Study design including data source, inclusion and exclusion criteria, components and derivation of unit costs, limitations and conclusions were qualitatively analysed. Results: Thirteen articles met the inclusion criteria. The treatment cost for hip fracture was undeniably high, with the average cost of treatment of US$6,595.79 (range: US$772-US$ 14,495). One study also reported that most expenses occurred at initial year of fracture event (97.4% of total average per-capita of US$3,850). Depending on length of stay (range: 7 and 45 days), cost of hospitalization could contribute between 1.72-97.91% (cost range: US$176.37-13,017) to the total cost of care. Likewise, the cost of surgical procedures ranged between US$266.31 and US$43,502, representing 2.59-54.6% of the total cost. Association between additional cost of treatment with factors such as age, and presence of comorbidities is still controversial. Overall, most studies adequately reported criteria for conducting economic evaluation, but there exists large variations in the methodological design of each study. This leads to difficulty for accurate estimation of hip fracture costs and generalization to inform decision makers. Conclusions: Management of osteoporosis-related hip fractures may possibly become unbearable to the government and societies, considering its parallel growth with ageing population in Asia. Establishment of high quality epidemiological databases and a wellstandardised collection of cost information would potentially provide more accurate information to assist decision makers and stakeholders in allocating resources for more cost-effective management of osteoporosis. PMS7 Evaluation of Health Care Costs and Utilization Patterns for Patients with Gout in Taiwan Lee Y1, Ko Y2, Wu C3, Tang C2, Kuo L1 1Taipei Medical University and Wan Fang Hospital, Taipei, Taiwan, 2Taipei Medical University, Taipei, Taiwan, 3Taipei Medical University, Taipei City, Taiwan
Objectives: As recommended in a recent review, there is a critical need for economic studies of gout that use large patient datasets, particularly in non-US countries. In addition, despite the higher incidence rate of gout in Taiwan compared to other countries, little is known about gout’s economic impact in Taiwan. Therefore, this study aims to examine the healthcare costs and utilization patterns for patients with gout in Taiwan from the perspective of the national health insurance. Methods: The National Health Insurance Research Database (NHIRD) was used to identify gout patients, and gout-free controls were matched with cases at a 1:3 ratio by age, gender, residential areas, and Charlson Comorbidity Index scores. Gout cases were defined as having (1) two primary or secondary diagnoses of gout on separate medical claims in 2011 or (2) one diagnosis of gout plus at least one gout-related pharmacy claim in 2011. Medical utilization and costs within the 365 days following the index date were assessed for both cases and controls. All costs were in new Taiwan dollars (NTDs). Results: A total of 21,376 gout patients met the inclusion criteria and were matched with 64,128 controls. Compared to controls, gout patients had more outpatient visits (mean: 31.8 vs. 22.8), more inpatient visits (mean: 1.8 vs. 1.7), and more emergency department (ED) visits (mean: 1.9 vs. 1.7). The mean (median) all-cause outpatient, inpatient, and ED costs of the cases were $34,815 ($20,162), $101,526 ($40,839), and $5,640 ($2,634), respectively. The mean (median) all-cause outpatient, inpatient, and ED costs of the controls were $30,068 ($12,802), $92,489 ($38,103), and $5,626 ($2,708), respectively. Conclusions: Patients with gout had higher all-cause healthcare utilization and costs compared with matched gout-free patients. These results could be useful both in future economic evaluations and as a starting point for efficiently and appropriately allocating healthcare resources. PMS8 Hospital Admissions and Inpatient Costs of Non-Union, Delayed Union and Mal-Union Following Long Bone Fracture Dunlop S1, Ekegren CL2, Edwards ER3, de Steiger R4, Page R5, Gabbe BJ2 1Zimmer Biomet, Belrose, Australia, 2Monash University, Melbourne, Australia, 3The Alfred Hospital, Prahran, Australia, 4Epworth Hospital, Richmond, Australia, 5University Hospital Geelong, Geelong, Australia
Objectives: Previous research into healing complications following long bone fractures has reported a wide range of cost estimates associated with their treatment. This research aims to describe hospital admissions and inpatient costs of hospital readmissions for healing complications following long bone fracture. Methods: All femoral, tibial and humeral fractures registered over a 5-year period by the Victorian Orthopaedic Trauma Outcomes Registry were linked with hospital datasets to identify 2-year readmissions for non-union, delayed union or mal-union. Outcomes reported included hospital admissions, length of stay and inpatient costs, derived using a case-mix approach based on Australian National Diagnosis Related Groups (AN-DRG). Results: Out of 3908 patients with long bone fractures, 9% (n= 337) were readmitted for healing complications within 2 years of their fracture. The most common type of complication resulting in readmission was non-union (7%). The majority of patients experiencing fracture healing complications were admitted
once within two years of their index fracture. However, 12% had 2 admissions for healing complications during this period, 2% had three admissions and 1% (n= 2) had four. The total inpatient costs for all admissions for fracture healing complications in this cohort was $5.4MAUD. The median inpatient hospital cost per patient for all complication admissions was $15,000AUD over and above the baseline fracture treatment costs and ranged from $9,500 to $25,000. The median hospital length of stay for all complication admissions was 3 days. Conclusions: Patients who develop fracture healing complications often have multiple admissions for treatment and incur high hospital inpatient costs. There is a need to prioritise future research aimed at preventing fracture healing complications and improving their management in order to reduce the additional burden placed on healthcare systems. PMS9 Modeling the Cost-Effectiveness of Statin Therapy in Rheumatoid Arthritis A Markov-Cycle Evaluation From the National Data Bank for Rheumatic Diseases Almasri D1, Lai L2, Michaud K3 University, Jeddah, Saudi Arabia, 2Nova Southeastern University, Davie, FL, USA, 3University of Nebraska Medical Center, Omaha, NE, USA
1King Abdulaziz
Objectives: Rheumatoid arthritis affects approximately 1% of the world’s population. In the United States, an estimated 1.5 million adults live with RA. Due to the high prevalence of comorbidities among patients with RA and the high costs of biologic therapies, the economic burden of the disease has become increasingly important. Researchers have recognized that treatment strategy should focus on both disease progression and comorbidity management. The purpose of our study is to determine the cost-effectiveness of using adjunctive statin therapy in combination with one or more biologic, versus biologic alone, in patients with RA. Methods: We first conducted analysis RA patients participating in the National Data Bank for Rheumatic Diseases (NDB) from 2003 through 2013 to identify study subjects and parameters used for further decision analysis. Second, a Markov simulation model with five-health state (low, mild, moderate, severe, and death defined by Health Assessments Questioner score) was developed to estimate quality-adjusted life years (QALYs) and costs associated with adding statin treatment to patients RA over 10 years. We evaluated strategies based on different adjunctive statin therapy to biologic (atorvastatin, rosuvastatin, simvastatin, lovastatin, fluvastatin, pravastatin,) compared to biologic alone. Transition probabilities and effectiveness measures (HAQ score improvements) were estimated from the NDB. Direct and indirect costs (2009 US dollars) were obtained from the literature. Both costs and effectiveness are discounted by 3% annually. Results: Our findings indicate that the clinical benefits of adjunctive statin therapy in treating RA disease progression resulted in $36,642/QALY over 10 years, compared to biologic alone. In the probabilistic analysis, combination statin and biologic were the dominant strategy in 60% of the simulations. Conclusions: This research provided evidence supporting the costeffectiveness of using adjunctive statin therapy in patients with RA. PMS10 Evaluate the Cost-Effective Threshold of Osteoporosis Treatment on Elderly Women in China Using Discrete Event Simulation Model Ni W, Jiang Y University of Southern California, Los Angeles, CA, USA
Objectives: Aging of the Chinese population will result in so many at risk of osteoporosis that economically efficient approaches to treat osteoporosis warrant consideration. This study evaluated the cost-effectiveness of osteoporosis treatment on senior Chinese women population. Methods: A discrete event simulation model using age specific probabilities of hip fracture, clinical vertebral fracture, wrist fracture, humerus fracture, other fracture, costs (2015 US dollars), and quality-adjusted life years (QALYs) was used to assess the cost-effectiveness of osteoporosis treatment. Incremental cost-effectiveness ratio (ICER) was calculated. The willingnessto-pay (WTP) for a QALY in China was compared with the calculated ICER to decide the cost-effectiveness. To determine the absolute10-year hip fracture probability at which the osteoporosis treatment became cost-effective, average age-specific probabilities for all fractures were multiplied by a relative risk (RR) that was systematically varied from 0 to 10 until the WTP threshold was observed for treatment relative to no intervention. Sensitivity analyses were also performed to evaluate the impacts from WTP and annual treatment costs. Results: In baseline analysis, simulated ICERs were higher than WTP threshold among Chinese women younger than 75, but much lower than WTP among the older population. Sensitivity analyses indicated that cost-effectiveness could vary due to a higher willingness-to-pay (WTP) threshold or a lower annual treatment costs. A 30% increase in WTP or a 30% reduction in annual treatment costs will make osteoporosis treatment cost-effective for Chinese women population from 55 to 85. Conclusions: Current study provides evidence that osteoporosis treatment is cost-effective among a subpopulation of Chinese senior women. The results also indicate that the cost-effectiveness of using osteoporosis treatment is sensitive to the WTP threshold and annual treatment costs. PMS11 Cost-Effectiveness of Bisphosphonates for Primary and Secondary Prevention of Hip-Related Fracture with Glucocorticoid-Induced Osteoporosis in Malaysia Mohd Tahir NA1, Thomas P2, Makmor Bakry M3, Mohamed Said MS4, Li SC1 1University of Newcastle, Callaghan, NSW, Australia, 2Taylor’s University, Selangor, Malaysia, 3Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia, 4Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
Objectives: Glucocorticoid therapy is associated with an appreciable risk of bone loss, eventually leads to increased fracture events. Osteoporosis-related fractures, especially of the hip, are associated with morbidity and mortality, reducing one’s quality of life. This study aims to evaluate the cost-effectiveness of bisphosphonates for prevention of glucocorticoid-induced osteoporosis (GIOP) in Malaysia. Methods: Retrospective data of effectiveness and cost were collected from medical and billing records of the Universiti Kebangsaan Malaysia Medical Centre between January 2013 and December
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 8 0 7 – A 9 1 8
associated with a higher risk of subsequent fractures. Conclusions: Subsequent fractures after an initial osteoporotic fracture bring significant healthcare burden in China. Identification of patients at a high risk of subsequent fractures and efforts on reducing their risk are needed. PMS6 Burden of osteoporosis-related hip fracture in asia. A review of health care costs and resource utilization Mohd Tahir NA1, Thomas P2, Li SC1 of Newcastle, Callaghan, NSW, Australia, 2Taylor’s University, Selangor, Malaysia
1University
Objectives: Osteoporotic fractures, especially hip fractures, impose large direct and indirect healthcare costs to the government and societies. The objective of this review was to systematically analyse available evidence on healthcare costs associated with osteoporosis-related hip fractures in Asia. Methods: Articles were systematically searched from databases including PubMed, EMBASE, Medline, and EBSCOHost between 2000 and 2015. Study design including data source, inclusion and exclusion criteria, components and derivation of unit costs, limitations and conclusions were qualitatively analysed. Results: Thirteen articles met the inclusion criteria. The treatment cost for hip fracture was undeniably high, with the average cost of treatment of US$6,595.79 (range: US$772-US$ 14,495). One study also reported that most expenses occurred at initial year of fracture event (97.4% of total average per-capita of US$3,850). Depending on length of stay (range: 7 and 45 days), cost of hospitalization could contribute between 1.72-97.91% (cost range: US$176.37-13,017) to the total cost of care. Likewise, the cost of surgical procedures ranged between US$266.31 and US$43,502, representing 2.59-54.6% of the total cost. Association between additional cost of treatment with factors such as age, and presence of comorbidities is still controversial. Overall, most studies adequately reported criteria for conducting economic evaluation, but there exists large variations in the methodological design of each study. This leads to difficulty for accurate estimation of hip fracture costs and generalization to inform decision makers. Conclusions: Management of osteoporosis-related hip fractures may possibly become unbearable to the government and societies, considering its parallel growth with ageing population in Asia. Establishment of high quality epidemiological databases and a wellstandardised collection of cost information would potentially provide more accurate information to assist decision makers and stakeholders in allocating resources for more cost-effective management of osteoporosis. PMS7 Evaluation of Health Care Costs and Utilization Patterns for Patients with Gout in Taiwan Lee Y1, Ko Y2, Wu C3, Tang C2, Kuo L1 1Taipei Medical University and Wan Fang Hospital, Taipei, Taiwan, 2Taipei Medical University, Taipei, Taiwan, 3Taipei Medical University, Taipei City, Taiwan
Objectives: As recommended in a recent review, there is a critical need for economic studies of gout that use large patient datasets, particularly in non-US countries. In addition, despite the higher incidence rate of gout in Taiwan compared to other countries, little is known about gout’s economic impact in Taiwan. Therefore, this study aims to examine the healthcare costs and utilization patterns for patients with gout in Taiwan from the perspective of the national health insurance. Methods: The National Health Insurance Research Database (NHIRD) was used to identify gout patients, and gout-free controls were matched with cases at a 1:3 ratio by age, gender, residential areas, and Charlson Comorbidity Index scores. Gout cases were defined as having (1) two primary or secondary diagnoses of gout on separate medical claims in 2011 or (2) one diagnosis of gout plus at least one gout-related pharmacy claim in 2011. Medical utilization and costs within the 365 days following the index date were assessed for both cases and controls. All costs were in new Taiwan dollars (NTDs). Results: A total of 21,376 gout patients met the inclusion criteria and were matched with 64,128 controls. Compared to controls, gout patients had more outpatient visits (mean: 31.8 vs. 22.8), more inpatient visits (mean: 1.8 vs. 1.7), and more emergency department (ED) visits (mean: 1.9 vs. 1.7). The mean (median) all-cause outpatient, inpatient, and ED costs of the cases were $34,815 ($20,162), $101,526 ($40,839), and $5,640 ($2,634), respectively. The mean (median) all-cause outpatient, inpatient, and ED costs of the controls were $30,068 ($12,802), $92,489 ($38,103), and $5,626 ($2,708), respectively. Conclusions: Patients with gout had higher all-cause healthcare utilization and costs compared with matched gout-free patients. These results could be useful both in future economic evaluations and as a starting point for efficiently and appropriately allocating healthcare resources. PMS8 Hospital Admissions and Inpatient Costs of Non-Union, Delayed Union and Mal-Union Following Long Bone Fracture Dunlop S1, Ekegren CL2, Edwards ER3, de Steiger R4, Page R5, Gabbe BJ2 1Zimmer Biomet, Belrose, Australia, 2Monash University, Melbourne, Australia, 3The Alfred Hospital, Prahran, Australia, 4Epworth Hospital, Richmond, Australia, 5University Hospital Geelong, Geelong, Australia
Objectives: Previous research into healing complications following long bone fractures has reported a wide range of cost estimates associated with their treatment. This research aims to describe hospital admissions and inpatient costs of hospital readmissions for healing complications following long bone fracture. Methods: All femoral, tibial and humeral fractures registered over a 5-year period by the Victorian Orthopaedic Trauma Outcomes Registry were linked with hospital datasets to identify 2-year readmissions for non-union, delayed union or mal-union. Outcomes reported included hospital admissions, length of stay and inpatient costs, derived using a case-mix approach based on Australian National Diagnosis Related Groups (AN-DRG). Results: Out of 3908 patients with long bone fractures, 9% (n= 337) were readmitted for healing complications within 2 years of their fracture. The most common type of complication resulting in readmission was non-union (7%). The majority of patients experiencing fracture healing complications were admitted
once within two years of their index fracture. However, 12% had 2 admissions for healing complications during this period, 2% had three admissions and 1% (n= 2) had four. The total inpatient costs for all admissions for fracture healing complications in this cohort was $5.4MAUD. The median inpatient hospital cost per patient for all complication admissions was $15,000AUD over and above the baseline fracture treatment costs and ranged from $9,500 to $25,000. The median hospital length of stay for all complication admissions was 3 days. Conclusions: Patients who develop fracture healing complications often have multiple admissions for treatment and incur high hospital inpatient costs. There is a need to prioritise future research aimed at preventing fracture healing complications and improving their management in order to reduce the additional burden placed on healthcare systems. PMS9 Modeling the Cost-Effectiveness of Statin Therapy in Rheumatoid Arthritis A Markov-Cycle Evaluation From the National Data Bank for Rheumatic Diseases Almasri D1, Lai L2, Michaud K3 University, Jeddah, Saudi Arabia, 2Nova Southeastern University, Davie, FL, USA, 3University of Nebraska Medical Center, Omaha, NE, USA
1King Abdulaziz
Objectives: Rheumatoid arthritis affects approximately 1% of the world’s population. In the United States, an estimated 1.5 million adults live with RA. Due to the high prevalence of comorbidities among patients with RA and the high costs of biologic therapies, the economic burden of the disease has become increasingly important. Researchers have recognized that treatment strategy should focus on both disease progression and comorbidity management. The purpose of our study is to determine the cost-effectiveness of using adjunctive statin therapy in combination with one or more biologic, versus biologic alone, in patients with RA. Methods: We first conducted analysis RA patients participating in the National Data Bank for Rheumatic Diseases (NDB) from 2003 through 2013 to identify study subjects and parameters used for further decision analysis. Second, a Markov simulation model with five-health state (low, mild, moderate, severe, and death defined by Health Assessments Questioner score) was developed to estimate quality-adjusted life years (QALYs) and costs associated with adding statin treatment to patients RA over 10 years. We evaluated strategies based on different adjunctive statin therapy to biologic (atorvastatin, rosuvastatin, simvastatin, lovastatin, fluvastatin, pravastatin,) compared to biologic alone. Transition probabilities and effectiveness measures (HAQ score improvements) were estimated from the NDB. Direct and indirect costs (2009 US dollars) were obtained from the literature. Both costs and effectiveness are discounted by 3% annually. Results: Our findings indicate that the clinical benefits of adjunctive statin therapy in treating RA disease progression resulted in $36,642/QALY over 10 years, compared to biologic alone. In the probabilistic analysis, combination statin and biologic were the dominant strategy in 60% of the simulations. Conclusions: This research provided evidence supporting the costeffectiveness of using adjunctive statin therapy in patients with RA. PMS10 Evaluate the Cost-Effective Threshold of Osteoporosis Treatment on Elderly Women in China Using Discrete Event Simulation Model Ni W, Jiang Y University of Southern California, Los Angeles, CA, USA
Objectives: Aging of the Chinese population will result in so many at risk of osteoporosis that economically efficient approaches to treat osteoporosis warrant consideration. This study evaluated the cost-effectiveness of osteoporosis treatment on senior Chinese women population. Methods: A discrete event simulation model using age specific probabilities of hip fracture, clinical vertebral fracture, wrist fracture, humerus fracture, other fracture, costs (2015 US dollars), and quality-adjusted life years (QALYs) was used to assess the cost-effectiveness of osteoporosis treatment. Incremental cost-effectiveness ratio (ICER) was calculated. The willingnessto-pay (WTP) for a QALY in China was compared with the calculated ICER to decide the cost-effectiveness. To determine the absolute10-year hip fracture probability at which the osteoporosis treatment became cost-effective, average age-specific probabilities for all fractures were multiplied by a relative risk (RR) that was systematically varied from 0 to 10 until the WTP threshold was observed for treatment relative to no intervention. Sensitivity analyses were also performed to evaluate the impacts from WTP and annual treatment costs. Results: In baseline analysis, simulated ICERs were higher than WTP threshold among Chinese women younger than 75, but much lower than WTP among the older population. Sensitivity analyses indicated that cost-effectiveness could vary due to a higher willingness-to-pay (WTP) threshold or a lower annual treatment costs. A 30% increase in WTP or a 30% reduction in annual treatment costs will make osteoporosis treatment cost-effective for Chinese women population from 55 to 85. Conclusions: Current study provides evidence that osteoporosis treatment is cost-effective among a subpopulation of Chinese senior women. The results also indicate that the cost-effectiveness of using osteoporosis treatment is sensitive to the WTP threshold and annual treatment costs. PMS11 Cost-Effectiveness of Bisphosphonates for Primary and Secondary Prevention of Hip-Related Fracture with Glucocorticoid-Induced Osteoporosis in Malaysia Mohd Tahir NA1, Thomas P2, Makmor Bakry M3, Mohamed Said MS4, Li SC1 1University of Newcastle, Callaghan, NSW, Australia, 2Taylor’s University, Selangor, Malaysia, 3Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia, 4Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
Objectives: Glucocorticoid therapy is associated with an appreciable risk of bone loss, eventually leads to increased fracture events. Osteoporosis-related fractures, especially of the hip, are associated with morbidity and mortality, reducing one’s quality of life. This study aims to evaluate the cost-effectiveness of bisphosphonates for prevention of glucocorticoid-induced osteoporosis (GIOP) in Malaysia. Methods: Retrospective data of effectiveness and cost were collected from medical and billing records of the Universiti Kebangsaan Malaysia Medical Centre between January 2013 and December