Authors: Alison B King K G Saag R T Burge M Pisu N Goel
Publish Date: 2005/06/08
Volume: 16, Issue: 12, Pages: 1545-1557
Abstract
Osteoporosis is a common debilitating disease affecting US Medicare beneficiaries yet diagnosis and treatment lag behind medical advances We estimated the cost of fractures to the Medicare program and the impact of increasing osteoporosis diagnosis and treatment A Markov model was used to predict fracture incidence and costs in postmenopausal women aged 65 years and older over 3 years 2001–2003 Only 180 million women were estimated to receive a Medicarereimbursed bone mineral density BMD test in 2001 We evaluated the budget impact of testing an additional 1 million women from Medicare and patient perspectives These women were stratified into highrisk osteoporotic with prevalent vertebral fracture and moderaterisk without prevalent vertebral fracture groups During 2001–2003 an estimated 239 million fractures occurred among the 511 million women aged 65+ with osteoporosis at a cost to Medicare of 1296 billion We projected that BMD testing of an additional 1 million women in 2001 would result in treatment of 440000 new patients with a bonespecific medication preventing over 35000 fractures over the 3 years The decrease in fractures would produce a net discounted savings to the Medicare budget of 7786 million Medicare’s hospital inpatient cost would decrease by 11541 million and longterm care cost by 4351 million more than offsetting incremental outpatient cost of 8107 million Patients would benefit from fracture avoidance but their outofpocket medical costs would increase by 6349 million during 2001–2003 or 1771 per fracture avoided Sensitivity analyses showed that savings to the Medicare program varied in proportion to the unit cost of fractures fracture risk of the populations tested treatment rate and adherence to therapy Increased osteoporosis diagnosis may produce savings for the Medicare program if interventions are targeted to women at elevated risk for fracture and may be budget neutral if all older women are screenedA related study which employed the same economic model but evaluated current BMD testing rates in the Medicare program was presented at the ACR Annual Meeting on October 28 2002 An abstract of that study was published in the Abstract Supplement for the meeting Arthritis Rheum 46 Supplement 9S583 abstract 1567
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