Isolating the Cost of Osteoporosis-Related Fracture for Postmenopausal Women

Abstract

Background: Osteoporosis is a condition that will pose an increasing burden on health systems as populations age. Objective: The objective of this study was to estimate the net ‘per case’ direct medical cost of fracture of indigent women age 50 years or greater and describe the cost of fracture for Medicaid and Medicare payers by inpatient hospital, physician, long-term care, prescription and miscellaneous expenditures. Methods: This study utilized a quasi-experimental retrospective interrupted time series design to isolate the economic impact of fracture. Administrative claims data for a continuous period of 24 months (12 months prior to fracture and 12 months after fracture) describing the Medicaid and Medicare expenditures for a cohort of women suffering from femur or other fracture in 1993 was abstracted and analyzed. ICD-9CM and CPT-4 codes were used to identify incident cases of fracture. Interrupted time series regression models were estimated using monthly expenditures. Results: A total of 765 Medicaid eligible women 50 years of age or greater experienced a fracture in the base year and met inclusion criteria. Of these, 226 experienced a femur fracture. The time series models detected significant increases in expenditures the month of fracture, however, total Medicaid expenditures returned to baseline trend charge in 7 and 5 months for femur and nonfemur fracture, respectively. Increases in long-term care expenditures persisted throughout the time series, but were offset by reductions in other categories of service. Conclusion: The net per case costs of femur and nonfemur fracture are about USD 3,300 and USD 1,300, respectively. The impact of fracture on Medicaid expenditures is temporary as costs rise sharply and return to baseline trend charges within a 12-month period.