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Fragility fracture-related direct medical costs in the first year following a nonvertebral fracture in a managed care setting

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Abstract

The objective of this study was to estimate the fracture-related direct medical costs during the first year following a fragility nonvertebral fracture in a managed care setting. This was a retrospective cohort study conducted among patients (aged 45+ years) with a primary diagnosis for a fragility nonvertebral fracture between July 1, 2000, and December 31, 2000, using MarketScan, an integrated administrative, medical, and pharmacy claims database. All patients had 6 months of observation prior to their fracture and 12 months following a nonvertebral fracture. Fracture-related direct medical costs were evaluated in the 12-month period following fracture diagnosis using 2003 Medicare fee schedule payments. The costs per fracture per year (PFPY) for specific nonvertebral fracture sites were determined, as well as costs by type of care (i.e., outpatient, inpatient, and other). A total of 4,477 women and men fulfilled the inclusion criteria. The sample was comprised of 73% women and the mean age was 70 years. The most prevalent nonvertebral fracture sites were wrist/forearm (37%), hip (25%), and humerus (15%). Mean total costs per patient per year were highest for fractures of the hip ($26,856), femur ($14,805), tibia ($10,224), and pelvis ($10,198). On average, 84% of the annual fracture-related costs were inpatient; 3% were outpatient, and 13% were long-term care and other costs. In a patient population aged 45+ years, the first month following a nonvertebral fracture has a major impact on medical care costs. The most costly nonvertebral fracture sites were hip, femur, and tibia fractures.

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Acknowledgements

This study was funded by Procter & Gamble Pharmaceuticals, Mason, OH, and Aventis Pharmaceuticals, Bridgewater, NJ

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Authors and Affiliations

  1. College of Public Health, University of Iowa, Iowa, USA

    Robert L. Ohsfeldt

  2. Iowa City VA Medical Center, Department of Health Management and Policy, 200 Hawkins Dr, Iowa City, IA, 52246, USA

    Robert L. Ohsfeldt

  3. Proctor and Gamble Pharmaceuticals Inc., 8700 Mason Montgomery Rd., Mason, OH, 45040, USA

    Natalie N. Borisov & Richard L. Sheer

Authors
  1. Robert L. Ohsfeldt
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  2. Natalie N. Borisov
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  3. Richard L. Sheer
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Corresponding author

Correspondence to Natalie N. Borisov.

Appendix: ICD-9-CM codes selected for nonvertebral fractures

Appendix: ICD-9-CM codes selected for nonvertebral fractures

Fractures were identified using the fracture-related International Classification of Diseases, 9th Edition, Clinical Modification diagnosis codes.

ICD-9-CM codes selected for non-vertebral fractures

Fracture site

ICD-9-CM

Clavicle (closed)

Closed

810.0x

Closed/open not indicated

810

Fermur (closed)

Pathologic

733.15

Shaft/unspecified

821.0x

Lower end

821.2x

Closed/open not indicated

821

Hip (closed)

Pathologic

733.14

Transcervical

820.0x

Pertrochanteric

820.2x

Unspecified

820.8x

Closed/open not indicated

820

Humerus (closed)

Pathologic

733.11

Upper end

812.0x

Shaft/unspecified

812.2x

Lower end

812.4x

Closed/open not indicated

812

Pelvis (closed)

Acetabulam

808.0x

Pubis

808.2x

Other specified

808.4x

Unspecified

808.8x

Closed/open not indicated

808

Tibia/fibula (closed)

Pathologic

733.16

Upper end

823.0x

Shaft

823.2x

Unspecified

823.8x

Closed/open not indicated

823

Wrist/forearm (closed)

Pathologic

733.12

Upper end

813.0x

Shaft

813.2x

Lower end

813.4x

Unspecified

813.8x

Closed/open not indicated

813

  1. The ICD-9-CM codes given reflect the specific 3-to 5-digit descriptor evaluated in the dataset. An “x” indicates that both the 4-digit code and all associated 5-digit subcodes were included

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Ohsfeldt, R.L., Borisov, N.N. & Sheer, R.L. Fragility fracture-related direct medical costs in the first year following a nonvertebral fracture in a managed care setting. Osteoporos Int 17, 252–258 (2006). https://doi.org/10.1007/s00198-005-1993-2

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  • DOI: https://doi.org/10.1007/s00198-005-1993-2

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