Abstract
Benefits for the patients and for the Health Care System could rise from the adoption of a global clinical approach (“disease management approach”) for osteoporosis and its fracture complications vs the current “component-based approach”. Disease management is a kind of method aimed to manage (from a clinical and managerial perspective) highly prevalent and expensive diseases from the prevention to treatment and rehabilitation in order to improve patient outcome and to lower costs in general.
Osteoporosis and its fracture complications in the Italian population meet the criteria of being highly prevalent and expensive. Four million women and 800,000 men in Italy suffer from osteoporosis. Furthermore, incidence and costs of hip fractures in the elderly Italian population (> 65 years old) are comparable to those of acute myocardial infarction in people aged > 45. Accordingly, we built a simulation model to evaluate potential benefits of a disease management approach.
Incidence and costs (including drug-related costs) of hip fractures registered in Italy in 2001 were compared to those predictable in the hypothesis of treating all individuals who have at least one vertebral fracture with bisphosphonates. Almost 1.5 million people in Italy are supposed to have a vertebral fracture and consequently an increased risk of hip fracture. We considered a NTT value of 40 (“Number To Treat”: number of patients to treat in order to prevent one hip fracture), according to the FIT study (Fracture Intervention Trial, involving 6,500 patients).
Only 6.4% of subjects with a vertebral fracture is currently receiving treatment with bisphosphonates. In this simulation, the extension of this anti-resorptive therapy to all individuals with vertebral fractures would produce a 48% reduction in the incidence of hip fractures (NTT=40) among people aged > 65 and increase global costs to an acceptable 21% rate.
The number of hospitalisations for hip fractures in the elderly would be reduced from 78,350 (2001) to 40,850 (simulation); direct costs for hospitalisation and surgery would pass from 438 million (2001) to 236 million Euros (simulation); general costs for rehabilitation from 416 million (2001) to 224 million Euros (simulation); indirect costs from 171 to 93 million Euros; drug-related costs would rise from 46 million (0.29% of the national pharmaceutical expenses) to 750 million Euros (4.4% of the national expenses). This study seems to confirm the benefits (with regards to health and cost of illness) of a disease management approach for osteoporosis and its fracture complications.
