10 research outputs found
Osteoporosis and fracture prevention: costs and effects modeled on the Rotterdam study
Osteoporosis is defined, by consensus, as a systemic skeletal disease. characterized by low
bone mass and microarchitectural deterioration of bone tissue with a consequent increase
in bone fragility and susceptibility to fracture,' It is well known that there is an important
age-related decrease in bone mass and bone strength as witnessed by the exponential
increase of hip fractures with age.2 Osteoporosis is primarily described in postmenopausal
women but men arc not free from it. and a quarter of the hip fractures
occurs in men.3
Osteoporosis and its direct consequences, fractures, are major concerns for public health
since they arc associated with increased death rates and with substantial disability.
:Moreover, they represent an important cost for the public health budget. 'TIle European
Commission estimated in a recent report the cost of osteoporosis in the countries of the
European Union at € 3.5 billion annually for hospital health care alone,4 and an American
study estimated the total health care expenditure attributable to osteoporotic fractures in
the United States at USS 13.8 billion (€ 12.4 billion) in 1995.' Without intervention, the
improved life expectancy and the demographic evolution will cause the number of hip
fractures worldwide to increase from around 1.7 million in 1990 to over 6 million in
2050.6 Therefore, it can be expected that medical expenditure will also increase in the
coming decades.
Osteoporosis, defined as a reduction in bone mass below a specified threshold, has been
shown to be a major determinant of fracture risk.7 Bone mass can be measured with
sufficient accuracy and precision and it is currently the best available indicator of fracture
risk, other than age and gender. There is, however, a considerable overlap of bone
density values between people who develop fractures and people who do not.2
The central goal of this thesis is to study the cost of osteoporosis and fractures in the
Netherlands and to develop mathematical models for estimating fracture risk based on
Dutch epidemiological data. These models are then used in simulations to analyze the
effects of potential preventive measures against osteoporotic fractures. 'The most
disabling of these is the hip fracture, but also wrist fractures and fractures of the
vertebrae are considered as osteoporotic fractures.8 Also from a cost perspective the
importance of hip fractures appears to be overwhelming, and therefore the models focus
is on hip fractures
Osteoporosis in the Netherlands; A burden of illness study commissioned by Merck Sharp & Dohme
This report provides an overview of the available quantitative information about osteoporosis in the Netherlands, and of the costs associated with it. We present information relevant for this country, making as few assumptions as possible. Although the main subject is osteoporosis, the focus in this report is on fractures, as these are the most relevant outcome events of this condition. Data were collected from publicly available data sources and from international literature and information is mostly about the year 1993.
The reader finds detailed information about the occurrence of osteoporosis and fractures, the utilization of health care, mortality, and the costs in the results section of this report. In the conclusions, we present a synthesis of the most important findings.
Osteoporosis is, by consensus, defined as a systemic skeletal disease, characterized by low bone mass and microarchitectural deterioration of bone tissue with a consequent increase in bone fragility and susceptibility to fracture. There is an important age-related decrease in bone mass and bone strength. Osteoporosis is primarily described in post-menopausal women but men are not free from it; they also reach high fracture incidence rates at an older age. Combined with the longer survival of women, this leads to the observation that most osteoporotic fractures are encountered in females.
Osteoporosis and fractures are a major source of illness and healthcare costs in the Netherlands, both today as in the foreseeable future. Especially the most serious consequence, hip fracture, is frequent and the incidence is increasing. The total number of hip fractures will inevitable rise if no serious prevention efforts are undertaken. For the prevention of osteoporotic fractures it is important to know who are at risk as well as which preventive strategy is effective for the different risk categories. The parameter that is most commonly used nowadays to determine fracture risk is bone mineral density (BMD), but also other factors are important contributors to the fracture risk, namely the previously mentioned bone quality and the propensity to fall. Prevention only focussed on bone mineral density will thus do nothing to prevent the hip fractures caused by the above mentioned factors. An additional effect of therapy on bone quality can be important and the intervention should certainly not have adverse effects on bone quality.
Reducing the frequency and severity of falls, and the use of external protective devices, together with physical exercise and other lifestyle interventions, have been looked at as additional intervention possibilities.
Patients with a hip fracture more often have concomitant illnesses and a poor general condition. This condition in itself can increase the risk of falling and the perioperative risk. This situation can also impair the rehabilitation after treatment and hamper mobilization.
Osteoporosis and fractures are found to be an important cause of health care consumption. Hip fractures lead to long hospita
Adult obesity and the burden of disability throughout life
OBJECTIVE: To analyze the prevalence of disability throughout life and
life expectancy free of disability, associated with obesity at ages 30 to
49 years. RESEARCH METHODS AND PROCEDURES: We used 46 and 20 years of
mortality follow-up, respectively, for 3521 Original and 3013 Offspring
Framingham Heart Study participants 30 to 49 years and classified as
normal weight, overweight, or obese at baseline. Disability measures were
available between 36 and 46 years of follow-up for 1352 Original
participants and at 20 years of follow-up for 2268 Offspring participants.
We measured the odds of disability in the Original cohort after 46 years
follow-up, and we estimated life expectancy with and without disability
from age 50. Two disability measures were used, one representing
limitations with mobility only and the second representing limitations
with activities of daily living (ADL). RESULTS: Obesity at ages 30 to 49
years was associated with a 2.01-fold increase in the odds of ADL
limitations 46 years later. Nonsmoking adults who were obese between 30
and 49 years lived 5.70 (95% confidence interval, 4.11 to 7.35) (men) and
5.02 (95% confidence interval, 3.36 to 6.61) (women) fewer years free of
ADL limitations from age 50 than their normal-weight counterparts. There
was no significant difference in the total number of years lived with
disability throughout life between those obese or normal weight, due to
both higher disability prevalence and higher mortality in the obese
population. DISCUSSION: Obesity in adulthood is associated with an
increased risk of disability throughout life and a reduction in the length
of time spent free of disability, but no substantial change in the length
of time spent with disability
Physical activity and life expectancy with and without diabetes: life table analysis of the Framingham Heart Study
OBJECTIVE: Physical activity is associated with a reduced risk of
developing diabetes and with reduced mortality among diabetic patients.
However, the effects of physical activity on the number of years lived
with and without diabetes are unclear. Our aim is to calculate the
differences in life expectancy with and without type 2 diabetes associated
with different levels of physical activity. RESEARCH DESIGN AND METHODS:
Using data from the Framingham Heart Study, we constructed multistate life
tables starting at age 50 years for men and women. Transition rates by
level of physical activity were derived for three transitions: nondiabetic
to death, nondiabetic to diabetes, and diabetes to death. We used hazard
ratios associated with different physical activity levels after adjustment
for age, sex, and potential confounders. RESULTS: For men and women with
moderate physical activity, life expectancy without diabetes at age 50
years was 2.3 (95% CI 1.2-3.4) years longer than for subjects in the low
physical activity group. For men and women with high physical activity,
these differences were 4.2 (2.9-5.5) and 4.0 (2.8-5.1) years,
respectively. Life expectancy with diabetes was 0.5 (-1.0 to 0.0) and 0.6
(-1.1 to -0.1) years less for moderately active men and women compared
with their sedentary counterparts. For high activity, these differences
were 0.1 (-0.7 to 0.5) and 0.2 (-0.8 to 0.3) years, respectively.
CONCLUSIONS: Moderately and highly active people have a longer total life
expectancy and live more years free of diabetes than their sedentary
counterparts but do not spend more years with diabetes
The risk and burden of vertebral fractures in Sweden
The aim of this study was to determine the risk and burden of vertebral fractures judged as those coming to clinical attention and as morphometric fractures. Incidence and utility loss were computed from data from Malmo, Sweden. Clinical fractures accounted for 23% of all vertebral deformities in women and for 42% in men. The average 10-year fracture probability for morphometric fractures increased with age in men from 2.9% at the age of 50 years (7.2% in women) to 8.4 at the age of 85 years (26.7% in women). As expected, probabilities increased with decreasing T-score for hip BMD. Cumulative utility loss from a clinical vertebral fracture was substantial and was 50-62% of that due to a hip fracture depending on age. When incidence of fractures in the population was weighted by disutility, all spine fractures accounted for more morbidity than hip fracture up to the age of 75 years. We conclude that vertebral fractures have a major personal and societal impact that needs to be recognised in algorithms for assessment of risk and in health economic strategies for osteoporosis
Intervention thresholds for osteoporosis in men and women: A study based on data from Sweden
The aim of this study was to determine the threshold of fracture probability at which interventions became cost-effective in men and women, based on data from Sweden. We modeled the effects of a treatment costing 200-500/year). Data on costs and risks were from Sweden. Costs included direct costs, but excluded indirect costs due to morbidity. A threshold for cost-effectiveness of approximately 500 per year; 35% efficacy) treatment in women was cost-effective with a 10-year hip fracture probability that ranged from 1.2% at the age of 50 years to 7.4% at the age of 80 years. Similar results were observed in men except that the threshold for cost-effectiveness was higher at younger ages than in women (2.0 vs 1.2%, respectively, at the age of 50 years). Intervention thresholds were sensitive to the assumed effectiveness and intervention cost. The exclusion of osteoporotic fractures other than hip fracture significantly increased the cost-effectiveness ratio because of the substantial morbidity from such other fractures, particularly at younger ages. We conclude that the inclusion of all osteoporotic fractures has a marked effect on intervention thresholds, that these vary with age, and that available treatments can be targeted cost-effectively to individuals at moderately increased fracture risk
Thiazide diuretics and the risk for hip fracture
BACKGROUND: Since most hip fractures are related to osteoporosis, treating accelerated bone loss can be an important strategy to prevent hip fractures. Thiazides have been associated with reduced age-related bone loss by decreasing urinary calcium excretion. OBJECTIVE: To examine the association between dose and duration of thiazide diuretic use and the risk for hip fracture and to study the consequences of discontinuing use. DESIGN: Prospective population-based cohort study. SETTING: The Rotterdam Study. PARTICIPANTS: 7891 individuals 55 years of age and older. MEASUREMENTS: Hip fractures were reported by the general practitioners and verified by trained research assistants. Details of all dispensed drugs were available on a day-to-day basis. Exposure to thiazides was divided into 7 mutually exclusive categories: never use, current use for 1 to 42 days, current use for 43 to 365 days, current use for more than 365 days, discontinuation of use since 1 to 60 days, discontinuation of use since 6
The polypill: at what price would it become cost effective?
Introduction: A promising concept in cardiovascular disease prevention (the polypill) was introduced in 2003. Although the polypill may seem as an effective intervention, data on its costs and cost effectiveness remain unknown. The aim of this study was to determine the maximum price of the polypill for it to be a cost effective alternative in the primary prevention of cardiovascular disease. Methods: Data on the hypothetical effects of the polypill were taken from the literature. Using data from the Framingham heart study and the Framingham offspring study, life tables were built to model the assumed benefits of the polypill. Using a third party payer perspective and a 10 years time horizon, the authors calculated what should be the maximum drug cost of the polypill for it to be cost effective (using a €20 000/year of life saved threshold) in the primary prevention of cardiovascular disease among populations at different levels of absolute risk of coronary heart disease and age. Results: To be cost effective among populations at levels of 10 year coronary heart disease risk over 20% (high risk), the annual cost of medication for the polypill therapy should be no more than €302 or €410 for men at age 50 and 60 years respectively. For cost effective prevention in populations at levels of coronary heart disease risk between 10% and 20% the costs should be two to three times lower. Conclusion: Although the polypill could theoretically be a highly effective intervention, the costs of the medication could be its caveat for implementation in
Effects of physical activity on life expectancy with cardiovascular disease
Background: Physical inactivity is a modifiable risk factor for cardiovascular disease. However, little is known about the effects of physical activity on life expectancy with and without cardiovascula