Direct costs of fractures in Canada and trends 1996-2006: a population-based cost-of-illness analysis

Cost-of-illness (COI) analysis is used to evaluate the economic burden of illness in terms of health care resource (HCR) consumption. We used the Population Health Research Data Repository for Manitoba, Canada, to identify HCR costs associated with 33,887 fracture cases (22,953 women and 10,934 men) aged 50 years and older that occurred over a 10-year period (1996-2006) and 101,661 matched control individuals (68,859 women and 32,802 men). Costs (in 2006 Canadian dollars) were estimated for the year before and after fracture, and the change (incremental cost) was modeled using quantile regression analysis to adjust for baseline covariates and to study temporal trends. The greatest total incremental costs were associated with hip fractures (median $16,171 in women and $13,111 for men), followed by spine fractures ($8,345 in women and $6,267 in men). The lowest costs were associated with wrist fractures ($663 in women and $764 in men). Costs for all fracture types were greater in older individuals (p < 0.001). Similar results were obtained with regression-based adjustment for baseline factors. Some costs showed a slight increase over the 10 years. The largest temporal increase in women was for hip fracture ($13 per year, 95% CI $6-$21, p < 0.001) and in men was for humerus fracture ($11 per year, 95% CI $3-$19, p = 0.007). At the population level, hip fractures were responsible for the largest proportion of the costs after age 80, but the other fractures were more important prior to age 80. We found that there are large incremental health care costs associated with incident fractures in Canada. Identifying COI from HCR use offers a cost baseline for measuring the effects of evidence-based guidelines implementation.