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. 2017 Oct;52(5):1794-1816.
doi: 10.1111/1475-6773.12554. Epub 2016 Sep 1.

The Costs of Fall-Related Injuries among Older Adults: Annual Per-Faller, Service Component, and Patient Out-of-Pocket Costs

Geoffrey J Hoffman  1 , Ron D Hays  2   3 , Martin F Shapiro  2   3 , Steven P Wallace  4 , Susan L Ettner  2
Affiliations

The Costs of Fall-Related Injuries among Older Adults: Annual Per-Faller, Service Component, and Patient Out-of-Pocket Costs

Geoffrey J Hoffman et al. Health Serv Res. 2017 Oct.

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.

Keywords: Medicare; direct medical expenditures; elderly; fall-related injuries; falls.

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Figures

Figure 1
Figure 1
Comparison of Unadjusted Annual Medical Expenditures for Older Medicare Beneficiaries (A) with and without Fall‐Related Injuries and (B) by Type of Index Injury for Those with a Fall‐Related Injury, 2007–2009

  1. Notes. Unadjusted expenditures for the 5,497 individuals in the analytic sample of the main model (using the case‐crossover with comparison group study design). Injuries are those that were identified as index FRIs in the analysis.

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