The economic burden in terms of cost of illness and generic health-related quality of life of posttraumatic long bone non-unions among the adult population of the Netherlands from a societal perspective

PURPOSE: This study assessed the societal economic burden in terms of cost of illness and health-related quality of life (HRQoL) of posttraumatic long bone non-unions in the Netherlands. METHODS: An incidence-based bottom-up approach was used, focusing on adult patients with posttraumatic long bone non-unions. The analysis included healthcare costs, patient and family costs, and productivity losses, measured using the iMCQ and iPCQ questionnaires. Cost evaluations followed Dutch costing guidelines, and productivity losses were calculated using the friction cost method. HRQoL was assessed with the EQ-5D-5L. A deterministic one-way sensitivity analysis varied baseline characteristics by ± 10%. Scenario analyses were conducted from healthcare and patient perspectives, as well as for patient subgroups. RESULTS: Average costs per patient during the three months before the initial visit at a non-union clinic were €8,928 (healthcare, N = 78), €1,360 (patient and family, N = 58), and €4,313 (productivity losses, N = 59), the average of the observed data calculates to 10,831 (N = 44). The mean EQ-5D-5L utility score was 0.390 (± 0.29 SD). Subgroup analysis showed no significant cost increase for patients with infections or open fractures. However, a higher Non-Union Severity Score and a lower HRQoL were significantly associated with higher total costs. CONCLUSION: Posttraumatic long bone non-unions pose a substantial economic burden on Dutch society and have a tremendous impact on HRQoL. Severe non-unions and a lower quality of life were associated with increased costs, whereas initial fracture characteristics were not. These findings highlight the importance of effective preventive and therapeutic strategies to reduce the burden of posttraumatic long bone non-unions.