Health Care Resource Utilization and Direct Medical Cost for Patients With Osteoporotic Fractures In Tianjin, China.

♦ Objective: To estimate 12-month osteoporosis-related health care resource utilization and direct medical cost for patients who were hospitalized with osteoporotic fractures in Tianjin, China. ♦ Methods: Data were obtained from Tianjin Urban Employee Basic Medical Insurance database (2008-2011). Included patients were ≥50 years old, with their first osteoporotic fracture hospitalization from January 1, 2009 to December 31, 2010, and had 12-month continuous enrollment before (baseline) and after (follow-up) the hospitalization. Both osteoporosisrelated health resource utilization and direct medical cost were estimated during the 12-month follow-up period. Comparisons of direct medical cost between different age groups, genders, and fracture types were conducted. Ordinary least square regression models were applied to identify factors associated with the annual direct medical cost and inpatient length of stay (LOS). ♦ Results: A total of 1839 patients were included, with mean age of 67.2 years, 58.2% female, and 89.0% retired. During the 12-month follow-up period, patients had 1.27±0.8 (mean±SD) hospitalizations on average due to osteoporotic fractures, and an average of 18.0±14.2 days LOS per admission. 19.5% of the patients experienced ≥1 osteoporotic fracture hospitalizations after the first one within 12 months. 45.2% experienced ≥1 osteoporosis-related outpatient visits, with the mean number of outpatient visits 7.6±8.1. The direct medical cost was 19917 CNY per hospital admission and 102 CNY per outpatient visit. The total mean direct medical cost was 25553 CNY per patient-year, the highest cost component was medical device cost (41.5%), followed by drug cost (28.1%), examination cost (11.0%), and treatment cost (8.2%). Cost increased as age increased, while it didn’t present significant differences in the cost regression model. Cost regression models revealed that female patients have a higher cost than male patients (27205 vs. 23246 CNY, P=0.031), patients with hip, lower limb, and multi-location fractures were more likely to have a higher cost and patients with rib fractures were more likely to have a lower cost in comparison with arm fracture patients (34899 CNY, 17883 CNY, 29375 CNY, and 13643 CNY vs.15657 CNY, p<0.05). LOS regression models revealed that older patients (≥70 years), patients with more comorbidities and patients with hip and lower limb fractures had longer LOS. ♦ Conclusions: Cost for patients with osteoporotic fractures was considerable, mainly driven by osteoporotic fracture hospitalizations. Among patients with osteoporotic fracture hospitalizations, females and those with hip, lower limb, and multiple-location fractures were more likely to incur more osteoporosis-related direct medical cost, and the LOS for older patients (≥70 years), patients with more comorbidities and patients with hip and lower limb fractures were longer than others. ♦