The savings factor between treatment of osteoporosis and treatment of subsequent osteoporotic fracture in the Netherlands.

Osteoporosis is characterized by reduced bone mineral density. Suffering from it implies that the risk of fracture increases. These so called fragility or osteoporotic fractures are regarded to be the most important clinical outcome of the disease for their inevitable ability to increase the financial and health burden in societies. Once experienced osteoporotic fracture, odds for subsequent fracture increase dramatically. Because of osteoporosis’ asymptomatic nature, people can suffer from it without noticing until the occurrence of fracture. In order to diagnose the disease, fracture patients can be scanned by use of the DEXA technique. Research has estimated, however, that only about 10% of fracture patients are actually diagnosed and treated properly while a widespread arsenal of anti-osteoporosis medication is available to counter bone loss and hence decrease relative risk of fracture. This thesis describes a model which has been designed to take the most important determinants of Dutch health care costs to osteoporosis into account and calculates the magnitude of the economic costs and benefits from treating osteoporosis in order to prevent its consequences. This research is primarily based on the medication benefits with respect to the prevention of subsequent fractures due to prior fracture, rather than the prevention of first fracture. The model design is intended to calculate the magnitude of the cost relation between: 1. the prevention of subsequent fractures through DEXA scanning and prescribing anti-osteoporosis medication after first fracture; and 2. the health care costs of treating the consequences of osteoporotic fracture. Where outcome estimates of the model tell that the financial burden of fragility fracture has been about € 700 million in 2010, it foresees a doubling of these costs by 2050. Moreover, this estimated extreme increase due to the ageing population too counts for the societal health burden. For 2010, the model estimates osteoporotic fracture to account for a total QALY loss of 40,800. This number is estimated to rise to 62,770 QALYs that will yearly be lost around 2050. These estimates are even likely to be underestimated. Since these predictions have solely been based on the ageing Dutch population, considering that the demographic evolution is an inevitable phenomenon, this raises the profile of an issue: How to minimize the increasing osteoporosis burden to society? This thesis describes the cost saving character of the prevention of subsequent osteoporotic fracture and the magnitude of the savings factor between the costs of preventing subsequent fracture and the costs of merely subsequent fracture repair, amounting 1.36 in 2020 in favor of fragility fracture prevention. This factor is likely to grow to a maximum of 12.82 by the year 2050 in the optimal scenario where all first and subsequent fractures can be prevented by i.e. risk assessment tools combined with adequate medication prescribing to people at high risk of fracture and where all anti-osteoporosis drugs are as cost-effective as the current most cost-effective available drugs. Fragility fracture prevention is predicted to enable an absolute cost saving per every 10% increase of combined screening and treating osteoporosis between the range of € 6 million (2020) to € 10 million (2050) per year in case of subsequent fragility fracture prevention and the range of € 18 million (2020) to € 28.5 million (2050) per year in the case of preventing both first and subsequent fragility fractures. Together with a predicted prevention of losing QALYs (i.e. 276 QALYs per year for subsequent fracture prevention and 827 QALYs per year for first and subsequent fracture prevention in 2020 for every 10% additional osteoporosis screening and treating) the study provides reason for discussion on the shift of focus from osteoporosis care to diagnosis and cure and justifies that the osteoporosis diagnosis gap should be closed instead of only focusing on the osteoporosis care gap.