April 8, 2015
Routine Post-Fracture Bisphosphonates: Cost-Prohibitive
for Older Women

Las Vegas—Routine bisphosphonate treatment of women over age 65 who sustain a distal radius fracture could significantly reduce the risk for additional fractures, primarily hip fractures, but at what cost?

A study presented recently at the 2015 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) estimated that price to be more than $2 billion annually.

Background information in the presentation, led by researchers at the Rothman Institute in Philadelphia, noted that osteoporosis affects 44 million Americans and contributes to about 2 million bone fractures each year.

In addition, the report pointed out, more than half of men and women older than 80 years meet diagnostic criteria for osteoporosis, which puts them at increased risk for bone fractures.

Hip fractures alone cause an estimated 300,000 unplanned hospital admissions in the United States each year. The lifetime cost of a hip fracture is estimated at $81,300, of which approximately 44% of the costs are associated with nursing-facility expenses.

For the study, researchers reviewed existing literature and Medicare data to determine distal radius fracture incidence and age-specific hip fracture rates after distal radius fracture with and without bisphosphonate treatment. They then created a model to determine future fracture rates with and without treatment, and related costs.

Predictions from the model included 357,656 lifetime hip fractures following distal radius fracture in all females age 65 and older in the U.S. If those patients received regular bisphosphonate treatment following a distal radius fracture, however, the projected number of hip fractures dropped to 262,767 over their lifetimes, the model indicated.

At the same time, an estimated 19,464 patients would suffer an atypical femur fracture as a result of bisphosphonate treatment, which has been associated with that condition in a small but significant number of patients, the report stated.

The price tag of routine bisphosphonate treatment, including the cost for treating associated atypical femur fractures, would be a lifetime total of $19.5 billion, or about $205,534 per avoided hip fracture.

“Our study suggests that routine universal utilization of bisphosphonates in elderly women after distal radius fracture would not be economically advantageous despite the cost savings associated with reduction of the hip fracture burden in that population,” explained lead study author, Suneel B. Bhat, MD, an orthopaedic surgery resident at the Rothman Institute.

The cost of bisphosphonates would need to drop to $70 per patient each year, from the current average annual wholesale cost of $1,485 per patient, to make the treatment affordable to provide every patient age 65 and older following a wrist fracture, the researchers suggested.
U.S. Pharmacist Social Connect