In less than a decade (2000–2008), over half a million hip fractures occurred in Italy, resulting in 800,000 hospital admissions, 120,000 expected deaths and over 150,000 cases of permanent invalidity. The direct costs to the Italian health service amount to around 8.5 billion euros (to which can be added another billion euros in disability pensions paid by the national social welfare institution). In recent years, the problem of hip fractures in the elderly has reached levels comparable only with those of myocardial infarction (MI) and stroke. The costs sustained for inpatient care and rehabilitation following hip fractures in the over-65s already exceed the hospital costs of all acute MIs in adults aged >45 years and are comparable to the direct costs of all strokes (ischaemic/haemorrhagic/TIAs) in Italy. Similarly, hip fracture mortality is no lower than MI and stroke mortality. In 2008, a total of 74,607 patients aged over 65 years were hospi-talised for hip fracture throughout Italy. These patients generated direct hospital costs of around 500 million euros/year plus a further 500 million euros for rehabilitation (making a total of over 1 billion euros/year). These costs are greater than those sustained for the hospitalisation and rehabilitation of MI and stroke patients aged over 45 years. An analysis of the Tuscan database of hospital discharge records on hip fractures highlighted the strong impact of this condition on the elderly and the considerable associated health costs: - Over 7,000 fragility fractures of the hip in 2007 alone. - Around 20% of elderly patients die within the first year. - Over 50% of hip fracture patients never recover movement capacity and independence. - Around 20% will suffer another hip fracture within 4 years. - 96 million euros in total direct costs to the regional heath service in 2007. Despite this, the percentage of elderly hip fracture patients receiving any anti-fracture therapy dropped from 13.1% to 12% between 2005 and 2007. The level of prevention is thus poor: a low percentage of fracture patients under treatment and low compliance (only 27% at 1 year). If the figure for Tuscany (13% under treatment) is extrapolated to the national setting, it is found that 9,200 hip fracture patients in Italy have been prescribed anti-fracture therapy, generating total expenditure of around 2.5 million euros (assuming 100% compliance). This corresponds to 0.026% of national drug spending! This is currently the most realistic picture of the situation regarding hip fracture patients. To treat all hip fracture patients aged over 65 years it would be necessary to spend a maximum of 18 million euros (or a hypothetical minimum of 3.5 million euros in the extreme case of i.v. infusions). Assuming optimal compliance, this figure, which corresponds to just 0.18% of national drug spending, would allow a population at high risk of fracture recurrence (of the hip or other site) to be treated effectively. This expenditure would, moreover, be offset by savings linked to reductions in the number of hip fracture recurrences (up to 30%) and, more generally, in the number of new fractures (5–10% a year). On the basis of therapeutic efficacy data, the estimated savings in terms of the costs of hospitalisation, operations and rehabilitation, would amount 43 million euros a year, not including the cost of the administered drugs.

Epidemiology of Fragility Fractures

IOLASCON, Giovanni;
2010

Abstract

In less than a decade (2000–2008), over half a million hip fractures occurred in Italy, resulting in 800,000 hospital admissions, 120,000 expected deaths and over 150,000 cases of permanent invalidity. The direct costs to the Italian health service amount to around 8.5 billion euros (to which can be added another billion euros in disability pensions paid by the national social welfare institution). In recent years, the problem of hip fractures in the elderly has reached levels comparable only with those of myocardial infarction (MI) and stroke. The costs sustained for inpatient care and rehabilitation following hip fractures in the over-65s already exceed the hospital costs of all acute MIs in adults aged >45 years and are comparable to the direct costs of all strokes (ischaemic/haemorrhagic/TIAs) in Italy. Similarly, hip fracture mortality is no lower than MI and stroke mortality. In 2008, a total of 74,607 patients aged over 65 years were hospi-talised for hip fracture throughout Italy. These patients generated direct hospital costs of around 500 million euros/year plus a further 500 million euros for rehabilitation (making a total of over 1 billion euros/year). These costs are greater than those sustained for the hospitalisation and rehabilitation of MI and stroke patients aged over 45 years. An analysis of the Tuscan database of hospital discharge records on hip fractures highlighted the strong impact of this condition on the elderly and the considerable associated health costs: - Over 7,000 fragility fractures of the hip in 2007 alone. - Around 20% of elderly patients die within the first year. - Over 50% of hip fracture patients never recover movement capacity and independence. - Around 20% will suffer another hip fracture within 4 years. - 96 million euros in total direct costs to the regional heath service in 2007. Despite this, the percentage of elderly hip fracture patients receiving any anti-fracture therapy dropped from 13.1% to 12% between 2005 and 2007. The level of prevention is thus poor: a low percentage of fracture patients under treatment and low compliance (only 27% at 1 year). If the figure for Tuscany (13% under treatment) is extrapolated to the national setting, it is found that 9,200 hip fracture patients in Italy have been prescribed anti-fracture therapy, generating total expenditure of around 2.5 million euros (assuming 100% compliance). This corresponds to 0.026% of national drug spending! This is currently the most realistic picture of the situation regarding hip fracture patients. To treat all hip fracture patients aged over 65 years it would be necessary to spend a maximum of 18 million euros (or a hypothetical minimum of 3.5 million euros in the extreme case of i.v. infusions). Assuming optimal compliance, this figure, which corresponds to just 0.18% of national drug spending, would allow a population at high risk of fracture recurrence (of the hip or other site) to be treated effectively. This expenditure would, moreover, be offset by savings linked to reductions in the number of hip fracture recurrences (up to 30%) and, more generally, in the number of new fractures (5–10% a year). On the basis of therapeutic efficacy data, the estimated savings in terms of the costs of hospitalisation, operations and rehabilitation, would amount 43 million euros a year, not including the cost of the administered drugs.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11591/225160
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