Coste de la fractura de cadera osteoporótica en España por comunidad autónoma / Cost of osteoporotic hip fracture in Spain per Autonomous Region

Objetivo: Se estimó la utilización de recursos sanitarios (URS) y costes asociados durante los 12 meses posteriores a una primera fractura de cadera osteoporótica (FCO) por comunidad autónoma (CC.AA.). Métodos: Estudio observacional, prospectivo, que incluyó pacientes ≥65años hospitalizados por una primera FCO en Andalucía, Cataluña, Comunidad Valenciana, Galicia, Madrid y País Vasco. Se registró la URS relacionada con la FCO, la calidad de vida y la autonomía del paciente, y se estimaron los costes asociados. Resultados: Participaron 487 pacientes (edad media: 83,1años, 77% mujeres), con características demográficas similares entre CC.AA. La duración media del ingreso fue más prolongada en Madrid y en Galicia (mujeres/hombres: 15,0/18,6 y 16,9/12,6 días) y menor en Andalucía y en la Comunidad Valenciana (8,2/7,2 y 8,4/9,4días). Las sesiones de rehabilitación y días de asistencia domiciliaria formal fueron más numerosos en Cataluña y en Madrid (mujeres/hombres: 16/21 y 17/29 sesiones; 19/20 y 30/27días) comparado con Andalucía y Galicia (4/1 y 3/0 sesiones; 3/1 y 1/0días). Los costes medios fueron más altos en Madrid y menores en Andalucía (mujeres/hombres: 12.321/12.297€ y 7.031/6.115€, respectivamente). Conclusiones: Las FCO implican un coste elevado para los sistemas sanitarios autonómicos, observándose diferencias notables entre CC.AA., derivadas principalmente de la duración diferencial de la primera estancia hospitalaria, así como al cuidado ambulatorio durante los meses posteriores. Estas diferencias podrían estar relacionadas con diferencias en la demora quirúrgica. Es deseable un abordaje y consenso a nivel nacional de este problema sanitario, con pautas de actuación comunes, ya que podría suponer grandes beneficios socioeconómicos y sanitarios globales

Objective: We estimated the health resource utilization (HRU) and associated costs during the 12months after a first osteoporotic hip fracture (OHF) in six Spanish Regions. Methods: Observational, prospective study including patients ≥65years-old hospitalized due to a first OHF in: Andalusia, Catalonia, Valencian Community, Galicia, Madrid and the Basque Country. HRU related to OHF, quality of life and patient autonomy were collected, and HRU-associated costs were estimated. Results: Four hundred and eighty-seven patients (mean age: 83.1years, 77% women) were included, with demographic characteristics that were similar across the Regions. Mean hospital stay was longest in Madrid and Galicia (women/men: 15.0/18.6 and 16.9/12.6days, respectively) and shortest in Andalusia and the Valencian Community (8.2/7.2 and 8.4/9.4days). There were more rehabilitation sessions and formal home care days in Catalonia and Madrid (women/men: 16/21 and 17/29 sessions; 19/20 and 30/27days) and fewer in Andalusia and Galicia (4/1 and 3/0 sessions; 3/1 and 1/0days). Mean HRU costs were higher in Madrid and lower in Andalusia (women/men: 12,321€/12,297€ and 7,031€/6,115€, respectively). Conclusions: OHF place a large burden on Spanish Regional Health Systems, including high economic costs. We found notable differences in mean costs across the Regions, mainly caused by the differential length of the first hospital stay and the outpatient care in subsequent months. These differences may be associated with differences in surgical delay. A national consensus on the management of OHF is desirable; moreover, agreeing common guidelines could have major socio-economic and healthcare benefits

Cost of osteoporotic hip fracture in Spain per Autonomous Region. / Coste de la fractura de cadera osteoporótica en España por comunidad autónoma.

OBJECTIVE: We estimated the health resource utilization (HRU) and associated costs during the 12months after a first osteoporotic hip fracture (OHF) in six Spanish Regions. METHODS: Observational, prospective study including patients ≥65years-old hospitalized due to a first OHF in: Andalusia, Catalonia, Valencian Community, Galicia, Madrid and the Basque Country. HRU related to OHF, quality of life and patient autonomy were collected, and HRU-associated costs were estimated. RESULTS: Four hundred and eighty-seven patients (mean age: 83.1years, 77% women) were included, with demographic characteristics that were similar across the Regions. Mean hospital stay was longest in Madrid and Galicia (women/men: 15.0/18.6 and 16.9/12.6days, respectively) and shortest in Andalusia and the Valencian Community (8.2/7.2 and 8.4/9.4days). There were more rehabilitation sessions and formal home care days in Catalonia and Madrid (women/men: 16/21 and 17/29 sessions; 19/20 and 30/27days) and fewer in Andalusia and Galicia (4/1 and 3/0 sessions; 3/1 and 1/0days). Mean HRU costs were higher in Madrid and lower in Andalusia (women/men: 12,321€/12,297€ and 7,031€/6,115€, respectively). CONCLUSIONS: OHF place a large burden on Spanish Regional Health Systems, including high economic costs. We found notable differences in mean costs across the Regions, mainly caused by the differential length of the first hospital stay and the outpatient care in subsequent months. These differences may be associated with differences in surgical delay. A national consensus on the management of OHF is desirable; moreover, agreeing common guidelines could have major socio-economic and healthcare benefits.

Persistencia en el tratamiento para la osteoporosis en pacientes posmenopáusicas en el ámbito de la Atención Primaria / Continuance of treatment for osteoporosis in postmenopausal patients in the Primary Care setting

Objetivo: Estimar la persistencia a los tratamientos para la osteoporosis posmenopáusica en el ámbito de Atención Primaria. Material y metodología: Estudio observacional, retrospectivo, realizado en seis centros de atención primaria. Criterios de inclusión: mujeres ≥ 50 años, diagnosticadas de osteoporosis que iniciaron tratamiento oral con bisfosfonatos, ranelato de estroncio o raloxifeno, entre enero de 2004 y junio de 2008. El objetivo principal fue estimar la persistencia global a un primer tratamiento para la osteoporosis posmenopáusica y la persistencia específica para cada tratamiento. En el análisis principal se consideró un cambio en el tratamiento como una interrupción y en el análisis secundario se permitió el cambio de tratamiento. Se consideraron tres cohortes de seguimiento: 1, 2 y 3 años. Los principales análisis estadísticos realizados fueron curvas de Kaplan-Meier, regresión logística y modelo de ANCOVA. Resultados: Se incluyeron 3.049 mujeres osteoporóticas. Grupos farmacológicos: 65% bisfosfonatos, 30% raloxifeno y 5% ralenato de estroncio. Edad media: 68 años; promedio del índice de Charlson: 0,4. En la cohorte 1 (N = 3.049) la persistencia global fue del 30%; en la cohorte 2 (N = 2.698) 35% y 16% a 1 y 2 años, respectivamente; en la cohorte 3 (N = 2.163) del 36%, 20% y 9% a 1,2 y 3 años, respectivamente (p < 0,01). La mediana de tiempo de persistencia para ácido alendrónico, risedrónico, raloxifeno y ralenato de estroncio fue de 149, 178, 210 y 89 días respectivamente (p < 0,001). Las variables asociadas a interrupción fueron: demencia, fracturas óseas y edad. Conclusiones: La persistencia en el tratamiento para la osteoporosis fue baja. Son necesarias nuevas estrategias para mejorar la persistencia de los tratamientos (AU)

Objective: To assess persistence to treatments for postmenopausal osteoporosis in primary care. Material and methodology: This retrospective, observational study was carried out in six Primary Care centers. Inclusion criteria: osteoporotic women 50 years or older, who initiated an oral treatment with bisphosphonates, raloxifene or strontium ranelate, between January 2004 and June 2008. The primary objective was to estimate persistence to treatment combining all treatments and by drug and regimen. In a primary analysis, switching treatments for postmenopausal osteoporosis was considered discontinuation, whereas in a secondary analysis, switching was allowed. Both analyses were performed on three follow-up-based cohorts according to data availability at 1, 2 and 3 years. Main statistical analyses performed were Kaplan-Meier curves, logistic regression and an ANCOVA model. Results: A total of 3,049 osteoporotic women were included. Pharmacological groups: 65% were treated with bisphosphonates, 30% with raloxifene and 5% with strontium ranelate. Mean age was 68 years; average Charlson co-morbidity index was 0.4. In cohort 1 (N = 3,049), persistence was 30%; in cohort 2 (N = 2,698), it was 35% and 16% at 1 and 2 years, respectively; in cohort 3 (N = 2,163), it was 36%, 20% and 9% at 1, 2 and 3 years, respectively (p < 0.01). Median duration of persistence to alendronic acid, risedronic acid, raloxifene and strontium ranelate was 149, 178, 210 and 89 days, respectively (p < 0.001). Variables associated with discontinuation were dementia, bone fractures and age (AU)