Medical Costs for Osteoporosis-Related Fractures in High-Risk Medicare Beneficiaries

Published in: Journal of the American Geriatrics Society, Volume 66, Issue 12, pages 2298–2304 (December 2018). doi: 10.1111/jgs.15585

Posted on RAND.org on November 13, 2020

by Kandice A. Kapinos, Shira H. Fischer, Andrew W. Mulcahy, Orla Hayden, Richard Barron

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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.

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