The direct and indirect costs of the chronic management of osteoporosis: a prospective follow-up of 3440 active subjects

Introduction: The objective of this study was to estimate the direct and indirect costs attributable to osteoporosis (OP) from a societal and a payer's perspective among active subjects living in Belgium and employed in the public workforce. Materials and methods: A cohort of 3440 subjects employed by the Liege City Council was followed for 6 months. The City Council employees were invited to fill a monthly log of the data related to their utilization of health resources ( contacts with health professionals, medical examinations, drug use,...) due to OP. Information on work disability ( number of days of sick leave) and on informal care ( number of days off work incurred by active subjects in helping relatives or friends suffering from OP) was also collected. Results: Of those asked to participate in the study, 1,811 subjects filled in at least one questionnaire. The mean duration of follow-up was 3.46 months. Self-reported prevalence of OP at inclusion was 5.3%. OP subjects were significantly older (52.7 +/- 6.1 years) than normal subjects (45.5 +/- 9.8 years) ( p< 0.05) and included more women (85.3 vs. 55.9%). Direct costs came to E44.6 per OP patient-month: E10.9 was spent on contact with health professionals, E19.0 on medical examinations, E12.1 on drugs and E2.6 on hospitalizations. During this 6-month study, a total of 140 days of sick leave was recorded ( mean: 0.4 per OP patient-month). From a payer's perspective, this loss in productivity yielded a mean cost of E34.05 per OP patient-month. A mean number of days off work of 0.018 per active subject-month, attributable to informal care, was recorded. These days of inactivity represented, for the employer, a mean cost of E1.8 per active subject-month. Conclusion: The results of this survey of a large sample of active subjects confirm that OP-related expenditures, both for medical care and for loss of productivity, are significant.