The costs of fall-related injuries among older adults: Annual per-faller, service component, and patient out-of-pocket costs.

TitleThe costs of fall-related injuries among older adults: Annual per-faller, service component, and patient out-of-pocket costs.
Publication TypeJournal Article
Year of Publication2017
AuthorsHoffman, GJ, Hays, RD, Shapiro, MF, Wallace, SP, Ettner, SL
JournalHealth Services Research
Volume52
Issue5
Pagination1794-1816
ISSN Number1475-6773
KeywordsFalls, Health Shocks, Medicare expenditures, Medicare/Medicaid/Health Insurance, Older Adults, Restricted data, Risk Factors
Abstract

OBJECTIVE: To estimate expenditures for fall-related injuries (FRIs) among older Medicare beneficiaries.

DATA SOURCES: The 2007-2009 Medicare claims and 2008 Health and Retirement Study (HRS) data for 5,497 (228 FRI and 5,269 non-FRI) beneficiaries.

STUDY DESIGN: FRIs were indicated by inpatient/outpatient ICD-9 diagnostic codes for fractures, trauma, dislocations, and by e-codes. A pre-post comparison group design was used to estimate the differential change in pre-post expenditures for the FRI relative to the non-FRI cohort (FRI expenditures). Out-of-pocket (OOP) costs, service category total annual FRI-related Medicare expenditures, expenditures related to the type of initial FRI treatment (inpatient, ED, outpatient), and the risk of persistently high expenditures (4th quartile for each post-FRI quarter) were estimated.

PRINCIPAL FINDINGS: Estimated FRI expenditures were $9,389 (95 percent CI: $5,969-$12,808). Inpatient, physician/outpatient, skilled nursing facility, and home health comprised 31, 18, 39, and 12 percent of the total. OOP costs were $1,363.0 (95 percent CI: $889-$1,837). Expenditures for FRIs initially treated in inpatient/ED/outpatient settings were $21,424/$6,142/$8,622. The FRI cohort had a 64 percent increased risk of persistently high expenditures. Total Medicare expenditures were $13 billion (95 percent CI: $9-$18 billion).

CONCLUSIONS: FRIs are associated with substantial, persistent Medicare expenditures. Cost-effectiveness of multifactorial falls prevention programs should be assessed using these expenditure estimates.

DOI10.1111/1475-6773.12554
Alternate JournalHealth Serv Res
Citation Key8686
PubMed ID27581952
PubMed Central IDPMC5583303