TY - JOUR
T1 - Medical Costs for Osteoporosis-Related Fractures in High-Risk Medicare Beneficiaries
AU - Kapinos, Kandice A.
AU - Fischer, Shira H.
AU - Mulcahy, Andrew
AU - Hayden, Orla
AU - Barron, Richard
N1 - Funding Information:
Sponsor’s Role: This project was supported by Amgen under a contract that provided for independent analysis by the authors. The role of the sponsor in each phase of the research was as follows. Design and conduct of the study: The sponsor requested a proposal for analysis from the authors. The authors and the sponsor designed and proposed the study, which the sponsor accepted. The authors conducted the study. Collection, management, analysis, and interpretation of the data: The authors obtained access to the restricted data used in this study and managed, analyzed, and interpreted the data. The sponsor reviewed output and provided feedback on results and modeling. Preparation, review, or approval of the manuscript: The authors prepared the manuscript. The sponsor reviewed the manuscript for comment, which the authors considered in further revisions. The authors had the authority to revise and submit the manuscript independently.
Publisher Copyright:
© 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society
PY - 2018/12
Y1 - 2018/12
N2 - OBJECTIVES: To estimate the incremental direct medical care costs associated with first fracture observable in high-risk older adults. DESIGN: Retrospective analysis of claims and survey data over a 3-year period from the Health and Retirement Study (HRS), a nationally representative biennial study of individuals aged 50 and older. SETTING: United States. PARTICIPANTS: Participants were HRS respondents who consented to have their Medicare claims data linked to the HRS data, were aged 65 or older, had at least 1 risk factor for fracture observable in the data, and experienced a fracture between 1996 and 2008 (n = 689) and their propensity score–matched controls (n = 689). MEASUREMENTS: Total Medicare, inpatient, outpatient, emergency department, physician office visit, and prescription drug care expenditures were primary outcomes. Two-staged generalized linear models were estimated using a difference-in-differences model. RESULTS: Fracture cases’ total Medicare expenditures increased by $13,929 (95% confidence interval (CI)=$11,920–15,938, p <.001) more than those of matched controls from the year before the index or fracture date to 1 year after the index date. Inpatient expenditures of $12,751 (95% CI=$10,790–14,7111, p <.001) more for fracture cases than comparison cases primarily drove this increase. Two and 3 years after fracture, there were no significant differences in growth in expenditures between the two groups. Results did not vary according to whether the fracture was at the hip or other site. CONCLUSION: Fractures impose a significant economic burden, especially in the first year after the fracture, in Medicare beneficiaries with at least 1 risk factor for fracture. Our sample was limited to community-dwelling individuals, and we are unable to control for fracture history before the study period. Costs may be greater for those in skilled nursing and similar facilities and for those who have had a previous fracture. J Am Geriatr Soc 66:2298–2304, 2018.
AB - OBJECTIVES: To estimate the incremental direct medical care costs associated with first fracture observable in high-risk older adults. DESIGN: Retrospective analysis of claims and survey data over a 3-year period from the Health and Retirement Study (HRS), a nationally representative biennial study of individuals aged 50 and older. SETTING: United States. PARTICIPANTS: Participants were HRS respondents who consented to have their Medicare claims data linked to the HRS data, were aged 65 or older, had at least 1 risk factor for fracture observable in the data, and experienced a fracture between 1996 and 2008 (n = 689) and their propensity score–matched controls (n = 689). MEASUREMENTS: Total Medicare, inpatient, outpatient, emergency department, physician office visit, and prescription drug care expenditures were primary outcomes. Two-staged generalized linear models were estimated using a difference-in-differences model. RESULTS: Fracture cases’ total Medicare expenditures increased by $13,929 (95% confidence interval (CI)=$11,920–15,938, p <.001) more than those of matched controls from the year before the index or fracture date to 1 year after the index date. Inpatient expenditures of $12,751 (95% CI=$10,790–14,7111, p <.001) more for fracture cases than comparison cases primarily drove this increase. Two and 3 years after fracture, there were no significant differences in growth in expenditures between the two groups. Results did not vary according to whether the fracture was at the hip or other site. CONCLUSION: Fractures impose a significant economic burden, especially in the first year after the fracture, in Medicare beneficiaries with at least 1 risk factor for fracture. Our sample was limited to community-dwelling individuals, and we are unable to control for fracture history before the study period. Costs may be greater for those in skilled nursing and similar facilities and for those who have had a previous fracture. J Am Geriatr Soc 66:2298–2304, 2018.
KW - HRS
KW - fracture
KW - medicare
KW - osteoporosis
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U2 - 10.1111/jgs.15585
DO - 10.1111/jgs.15585
M3 - Article
C2 - 30289961
AN - SCOPUS:85054510880
SN - 0002-8614
VL - 66
SP - 2298
EP - 2304
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 12
ER -