scholarly journals Fragility fractures in Europe: burden, management and opportunities

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Fredrik Borgström ◽  
◽  
Linda Karlsson ◽  
Gustav Ortsäter ◽  
Nicolas Norton ◽  
...  
Keyword(s):  
Fragility Fractures ◽  
Chronic Obstructive ◽  
Economic Modelling ◽  
The European Union ◽  
Treatment Gap ◽  
Quality Adjusted Life Years ◽  
Fracture Liaison Services ◽  
Life Years ◽  
Fracture Liaison ◽  
Quality Adjusted Life

Abstract Summary This report provides an overview and a comparison of the burden and management of fragility fractures in the largest five countries of the European Union plus Sweden (EU6). In 2017, new fragility fractures in the EU6 are estimated at 2.7 million with an associated annual cost of €37.5 billion and a loss of 1.0 million quality-adjusted life years. Introduction Osteoporosis is characterized by reduced bone mass and strength, which increases the risk of fragility fractures, which in turn, represent the main consequence of the disease. This report provides an overview and a comparison of the burden and management of fragility fractures in the largest five EU countries and Sweden (designated the EU6). Methods A series of metrics describing the burden and management of fragility fractures were defined by a scientific steering committee. A working group performed the data collection and analysis. Data were collected from current literature, available retrospective data and public sources. Different methods were applied (e.g. standard statistics and health economic modelling), where appropriate, to perform the analysis for each metric. Results Total fragility fractures in the EU6 are estimated to increase from 2.7 million in 2017 to 3.3 million in 2030; a 23% increase. The resulting annual fracture-related costs (€37.5 billion in 2017) are expected to increase by 27%. An estimated 1.0 million quality-adjusted life years (QALYs) were lost in 2017 due to fragility fractures. The current disability-adjusted life years (DALYs) per 1000 individuals age 50 years or more were estimated at 21 years, which is higher than the estimates for stroke or chronic obstructive pulmonary disease. The treatment gap (percentage of eligible individuals not receiving treatment with osteoporosis drugs) in the EU6 is estimated to be 73% for women and 63% for men; an increase of 17% since 2010. If all patients who fracture in the EU6 were enrolled into fracture liaison services, at least 19,000 fractures every year might be avoided. Conclusions Fracture-related burden is expected to increase over the coming decades. Given the substantial treatment gap and proven cost-effectiveness of fracture prevention schemes such as fracture liaison services, urgent action is needed to ensure that all individuals at high risk of fragility fracture are appropriately assessed and treated.

Identifying Public Health Problems

2018 ◽  
Author(s):  
Scott Burris ◽  
Micah L. Berman ◽  
Matthew Penn, and ◽  
Tara Ramanathan Holiday
Keyword(s):  
Public Health ◽  
Health Problems ◽  
Health Priorities ◽  
Disability Adjusted Life Years ◽  
Quality Adjusted Life Years ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Study Designs ◽  
Quality Adjusted Life

Chapter 5 discusses the use of epidemiology to identify the source of public health problems and inform policymaking. It uses a case study to illustrate how researchers, policymakers, and practitioners detect diseases, identify their sources, determine the extent of an outbreak, and prevent new infections. The chapter also defines key measures in epidemiology that can indicate public health priorities, including morbidity and mortality, years of potential life lost, and measures of lifetime impacts, including disability-adjusted life years and quality-adjusted life years. Finally, the chapter reviews epidemiological study designs, differentiating between experimental and observational studies, to show how to interpret data and identify limitations.

Medicare’s Hospital Value-Based Purchasing Program Values Quality over QALYs

2021 ◽  
pp. 0272989X2110171
Author(s):  
Edward C. Norton ◽  
Jun Li ◽  
Anup Das ◽  
Andrew M. Ryan ◽  
Lena M. Chen
Keyword(s):  
Quality Of Care ◽  
Pay For Performance ◽  
Health Interventions ◽  
Quality Adjusted Life Years ◽  
Value Based Purchasing ◽  
Quality Performance ◽  
Life Years ◽  
Policy Adjustments ◽  
Quality Adjusted Life

Medicare’s Hospital Value-Based Purchasing Program (HVBP) is the first national pay-for-performance program to combine measures of quality of care with a measure of episode spending. We estimated the implicit tradeoffs between mortality reduction and spending reduction. To earn points in HVBP, a hospital can either lower mortality or reduce spending, creating a tradeoff between the 2 measures. We analyzed the quality performance and earned points of 2814 hospitals using publicly available data. We then quantified the tradeoffs between spending and mortality in terms of quality-adjusted life-years (QALYs). If incentives in the program were balanced, then the tradeoff between spending and QALYs should be comparable with those of high-value health interventions, roughly $50,000 to $200,000 per QALY. Instead, the tradeoff in HVBP was about $1.2 million per QALY. HVBP overvalues improvements in quality of care relative to spending reductions. We propose 2 possible policy adjustments that could improve incentives for hospitals to deliver high-value care.

Good, Fairness and QALYs

1988 ◽  
Vol 23 ◽  
pp. 57-73 ◽  
Author(s):  
John Broome
Keyword(s):  
Health Service ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Quality Adjusted Life

Counting QALYs (quality adjusted life years) has been proposed as a way of deciding how resources should be distributed in the health service: put resources where they will produce the most QALYs. This proposal has encountered strong opposition. There has been a disagreement between some economists favouring QALYs and some philosophers opposing them. But the argument has, I think, mostly been at cross-purposes. Those in favour of QALYs point out what they can do, and those against point out what they can't. There need be no disagreement about this. What is needed is to sort out what is the proper domain of QALYs, and it may be possible to do this amicably. Then we may be able to get on with the more useful job of deciding how well QALYs perform within their domain. In this paper I shall try to accomplish the first task (sections II–IV), and make a start on the second (sections V–VIII).

Utilities and Quality-Adjusted Life Years

1989 ◽  
Vol 5 (4) ◽  
pp. 559-575 ◽  
Author(s):  
George W. Torrance ◽  
David Feeny
Keyword(s):  
Quality Of Life ◽  
Cost Utility ◽  
Health Improvement ◽  
Quality Adjusted Life Years ◽  
Utility Analysis ◽  
Quality Adjustment ◽  
Life Years ◽  
Quality Adjusted Life ◽  
Broad Overview

Utilities and quality-adjusted life years (QALYs) are reviewed, with particular focus on their use in technology assessment. This article provides a broad overview and perspective on these two techniques and their interrelationship, with reference to other sources for details of implementation. The historical development, assumptions, strengths/weaknesses, and applications of each are summarized.Utilities are specifically designed for individual decision-making under uncertainty, but, with additional assumptions, utilities can be aggregated across individuals to provide a group utility function. QALYs are designed to aggregate in a single summary measure the total health improvement for a group of individuals, capturing improvements from impacts on both quantity of life and quality of life– with quality of life broadly defined. Utilities can be used as the quality-adjustment weights for QALYs; they are particularly appropriate for that purpose, and this combination provides a powerful and highly useful variation on cost-effectiveness analysis known as cost-utility analysis.

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