A162 Abstracts OBJECTIVES: This study aimed to investigate the effect of long term persistent bisphosphonate usage on the risk for hospital- ization due to osteoporotic fractures. METHODS: The PHARMO database, which includes linked drug-dispensing records and hospital discharge records for more than two million subjects in defined areas in the Netherlands, was used to iden- tify new female users of alendronate, etidronate or risedronate >50 years in the period January 1996–June 2003. Persistence with bisphosphonate treatment was determined using the method of Catalan. Within the cohort a matched case control study was performed. Cases were selected on the basis of a first hospitalization for an osteoporotic fracture (index date). Con- trols were matched 10 : 1 to cases on year of inclusion in the cohort and were assigned a random index date. The association with risk for fractures was assessed for persistent bisphospho- nate use for one and two years prior to the index date. Analy- ses were adjusted for differences in patient characteristics such as age, previous hospitalization for fractures, co-morbidity and co-medication. RESULTS: There were 14,760 new female users of bisphosphonates were identified of which 541 women had a hospitalization for osteoporotic fracture during follow-up. One- year persistence rates improved with less frequent dosing (e.g. 33% with alendronate daily to 48% with alendronate weekly, an increase of 15%). Similar results were obtained with rise- dronate daily and weekly. One year persistent use of bisphos- phonates resulted in a significant 35% lower fracture rate (OR 0.74; 95%CI 0.57–0.95) whereas two year persistent use resulted in a 47% lower rate (OR 0.68; 95%CI 0.47–0.96). CONCLUSIONS: These results emphasize the importance of persistent bisphosphonate usage to obtain the maximal protec- tive effect of treatment. Persistence with bisphosphonates is higher with less frequent dosing regimens but is still suboptimal. This study has demonstrated that improving persistence results in reduced hospitalization for osteoporotic fractures. POS2 THE EFFECT OF RISK FACTORS ON MORTALITY AFTER PRIMARY TREATMENT OF FEMORAL NECK FRACTURE AT DIFFERENT TIME PERIODS IN HUNGARY Sebestyén A 1 , Boncz I 2 , Sándor J 3 , Ember I 3 , Nyárády J 3 1 National Health Insurance Fund Administration (OEP), Pécs, Hungary, 2 National Health Insurance Fund Administration (OEP), Budapest, Hungary, 3 University of Pécs, Pécs, Hungary OBJECTIVES: The aim of the study is to analyze the lethality after femur neck fractures at different time. We analyze the chance of lethality from the time of primary treatment of femoral neck fracture at different time periods according to age-group, sex and most frequently used surgical techniques. METHODS: Data derive from the database of the National Health Insurance Fund Administration and based on the ICD-10 S7200 code. The bases of the evaluation are patients over 65 with femoral neck fracture identified with Social Security Identification Number (TAJ) discharged from inpatient care institutions after primary treatment. The following time periods were included into the analysis: 0–30 days, 31–90 days, 91–180 days, 181–270 days, 271–360 days. The patients with polytrauma were excluded from the study. Regarding surgical methods, the most frequently used screw fixation and arthroplasty were evaluated. Statistical analysis means logistic regression and reference values were: males, universities and arthroplasty. RESULTS: Altogether 4141 patients were included into the study. Female:male ratio was 23.71% : 76.29%. Sex: The female lethality was significantly lower than male in the first half a year: in 0–30 days 0.527 (0.4398–0.6947), in 31–90 days 0.6156 (0.4897–0.7738), in 91–180 days 0.6378 (0.479–0.8491). Increasing age resulted in a significantly higher chance of lethality: 0–30 days 7.36% 1.0736 (1.0583–1.0891), 31–90 days 6.56% 1.0656 (1.0507–1.0807), 91–180 days 3.66% 1.0366 (1.0186–1.055), 181–270 days 3.96% 1.0396 (1.0168–1.0628), 271–360 days 2.93% 1.0293 (1.0053–1.0538). According to surgical METHODS: arthroplasty 15.21%, screw fixation: 69.72%. Lethality after screw fixation was significantly higher in 0–30 days 1.9873 (1.366–2.9547) and 91–180 days 1.7168 (1.0931–2.6965). CONCLUSIONS: The chance of lethality depending on age-group highlighted the importance of early postoperative period. Higher age-groups, males and surgical methods might have an effect at different level on mortality. OSTEOPOROSIS—Cost Studies POS3 BUDGET IMPACT ANALYSIS OF BISPHOSPHONATES FOR FRACTURES IN POSTMENOPAUSAL WOMEN Nishida LM 1 , Ramsey SD 2 1 The Regence Group, Portland, OR, USA, 2 Fred Hutchinson Cancer Research Center, Seattle,WA, USA OBJECTIVE: To estimate from a health plan perspective the budget impact of treating postmenopausal women with bispho- sphonates (alendronate, risedronate) to prevent hip and vertebral fractures. METHODS: The annual budget impact was calculated by estimating annual expenditures for bisphosphonate treatment less the cost of hip or vertebral fractures prevented per year from treatment. Data from pivotal clinical trials was used to estimate the number of clinically significant vertebral or hip fractures pre- vented with bisphosphonates. Cost of a fracture was based on medical claims data for women hospitalized for hip or vertebral fractures from January 1, 2003–December 31, 2004. Medication costs were based on average wholesale price for average dosing of bisphosphonates ¥365 days, assuming 100% compliance with therapy. RESULTS: Annual medication costs for treatment were $9.9 million for risedronate and $10.3 million for alendronate per 10,000 women. Annual savings from averted fractures per 10,000 women were $3.1–$3.8 million for high risk women and $22,000–$33,000 for low risk women. The annual net budget impact was $6.5–$6.8 million for high risk women and $9.8 to $10.3 million for low risk women. Medication costs were about three times higher in high risk women and 375 times higher in low risk women than costs of hip or vertebral fractures pre- vented. Limitations: As medication adherence is less than 100% in practice, actual fracture prevention rates and medication costs are likely to be less than the trial-based outcomes used for this analysis. The analysis does not include quality of life, survival impacts related to fractures, or cost impacts of treatment-related adverse events. CONCLUSIONS: Using ideal assumptions for baseline fracture risk and medication adherence, treatment costs for bisphosphonates far exceed savings resulting from fractures prevented. Postmenopausal women with high fracture risks show the greatest benefits and offsets in treatment costs. POS4 COMPARATIVE ANALYSIS OF HEALTH INSURANCE COST OF MEDIAL FEMORAL NECK FRACTURES WITH AND WITHOUT COMPLICATIONS ON A 2 YEARS FOLLOW UP Sebestyén A 1 , Boncz I 1 , Dózsa C 2 , Nyárády J 3 1 National Health Insurance Fund Administration (OEP), Budapest, Hungary, 2 Ministry of Health, Budapest, Hungary, 3 University of Pécs, Pécs, Hungary OBJECTIVES: To analyze the health insurance cost of medial femoral neck fractures treated with arthroplasty, screw fixation and dynamic hip screw (DHS) methods on a 2 years follow up