Pathologic fracture and healthcare resource utilisation: A retrospective study in eight European countries

Abstract

BackgroundSkeletal-related events (SREs; pathologic fracture [PF], spinal cord compression and radiation or surgery to bone) are common complications of bone metastases or bone lesions and can impose a considerable burden on patients and healthcare systems. In this study, the healthcare resource utilisation (HRU) associated with PFs in patients with bone metastases or lesions secondary to solid tumours or multiple myeloma was estimated in eight European countries.MethodsEligible patients were identified in Austria, the Czech Republic, Finland, Greece, Poland, Portugal, Sweden and Switzerland. HRU data were extracted from hospital charts from 3.5 months before the index PF (defined as a PF preceded by a 6.5-month period without a SRE) until 3 months after the last SRE during the study period. Changes from baseline in the number and duration of inpatient stays, number of outpatient visits and number of procedures provided were recorded.ResultsOverall, 118 patients with PFs of long bones (those longer than they are wide, e.g. the femur) and 241 patients with PFs of other bones were included. Overall, HRU was greater in patients with long bone PFs than in those with PFs of other bones. A higher proportion of patients with long bone PFs had multiple SREs (79.7%), and more of their SREs were considered to be linked (73.4%) compared with patients with PFs of other bones (51.0% and 47.2%, respectively).ConclusionThe increased number and duration of inpatient stays for PFs of long bones compared with those for PFs of other bones may be due in part to the requirement for complicated and lengthy rehabilitation in patients with long bone PFs. Implementing strategies to delay or reduce the number of PFs experienced by patients with bone metastases or lesions may therefore reduce the associated HRU and patient burden.

Healthcare resource utilisation associated with skeletal‐related events in European patients with multiple myeloma: Results from a prospective, multinational, observational study

“…Previous studies have shown that, in particular, surgery to bone is associated with long inpatient stays in patients with solid tumours or MM . Several retrospective studies in the United States of America (USA) and Europe that included patients with MM demonstrated increased healthcare resource utilisation (HRU) and/or costs associated with SREs . Although these data provide some insight into the impact that SREs have on HRU by these patients, they may be limited by the scope and completeness of the available HRU data and by the use of codes (clinical and/or administrative) as proxies for diagnosis and resource use.…”

“…3,9 Several retrospective studies in the United States of America (USA) and Europe that included patients with MM demonstrated increased healthcare resource utilisation (HRU) and/or costs associated with SREs. 3,4,[10][11][12][13] Although these data provide some insight into the impact that SREs have on HRU by these patients, they may be limited by the scope and completeness of the available HRU data and by the use of codes (clinical and/or administrative) as proxies for diagnosis and resource use. Prospective data, collected from a broader European population, could provide more extensive, complete and robust information on the real-life use of healthcare resources in the treatment of SREs to better inform optimum approaches for patient management and healthcare planning.…”

Mirels Scores in Patients Undergoing Prophylactic Stabilization for Femoral Metastatic Bone Disease in the Veterans Administration Healthcare System

“… 18 , 19 Prophylactically stabilizing a metastatic lesion (compared with the fixation of a completed pathological fracture) is cost-effective, lessens the burden on the healthcare system, and is associated with an improvement in overall survival. 4 , 20 , 21 Furthermore, these surgeries tend to be less morbid with shorter hospital stays and higher likelihood of discharge to home rather than a facility.…”

The role of postoperative radiation and coordination of care in patients with metastatic bone disease of the appendicular skeleton

“…41 These examples bring to light the importance of clear communication and appropriate referral as morbidity, mortality, and cost can be reduced with prompt management of impending pathologic fracture. 7 , 19 , 20 , 39…”