Andrich S, Haastert B, Neuhaus E, Frommholz K, Arend W, Ohmann C, Grebe J, Vogt A, Brunoni C, Jungbluth P, Thelen S, Dintsios C-M, Windolf J, Icks A
Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz-Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
Osteoporos Int. 2021 Oct;32(10):2061-2072. doi: 10.1007/s00198-021-05935-1. Epub 2021 Apr 10.
Our study demonstrates a strong increase in utilization of inpatient health care and clear excess costs in older people in the first year after pelvic fracture, the latter even after adjustment for several confounders. Excess costs were particularly high in the first few months and mainly attributable to inpatient treatment.
We aimed to estimate health care utilization and excess costs in patients aged minimum 60 years up to 1 year after pelvic fracture compared to a population without pelvic fracture.
In this retrospective population-based observational study, we used routine data from a large statutory health insurance (SHI) in Germany. Patients with a first pelvic fracture between 2008 and 2010 (n=5685, 82% female, mean age 80±9 years) were frequency matched with controls (n=193,159) by sex, age at index date, and index month. We estimated health care utilization and mean total direct costs (SHI perspective) with 95% confidence intervals (CIs) using BCA bootstrap procedures for 52 weeks before and after the index date. We calculated cost ratios (CRs) in 4-week intervals after the index date by fitting mixed two-part models including adjustment for possible confounders and repeated measurement. All analyses were further stratified for men/women, in-/outpatient-treated, and major/minor pelvic fractures.
Health care utilization and mean costs in the year after the index date were higher for cases than for controls, with inpatient treatment being particularly pronounced. CRs (95% CIs) decreased from 10.7 (10.2-11.1) within the first 4 weeks to 1.3 (1.2-1.4) within week 49-52. Excess costs were higher for inpatient than for outpatient-treated persons (CRs of 13.4 (12.9-13.9) and 2.3 (2.0-2.6) in week 1-4). In the first few months, high excess costs were detected for both persons with major and minor pelvic fracture.
Pelvic fractures come along with high excess costs and should be considered when planning and allocating health care resources.
我们的研究表明，骨盆骨折后的第一年，老年人住院医疗的利用率大幅上升，且存在明显的额外费用，即使在对多个混杂因素进行调整后，后者依然存在。最初几个月的额外费用尤其高，且主要归因于住院治疗。
我们旨在评估年龄在60岁及以上的骨盆骨折患者在骨折后长达1年的医疗利用率和额外费用，并与无骨盆骨折的人群进行比较。
在这项基于人群的回顾性观察研究中，我们使用了德国一家大型法定医疗保险（SHI）的常规数据。2008年至2010年间首次发生骨盆骨折的患者（n = 5685，82%为女性，平均年龄80±9岁）按性别、索引日期时的年龄和索引月份与对照组（n = 193,159）进行频数匹配。我们使用BCA自助法程序估计索引日期前后52周的医疗利用率和平均总直接费用（从SHI角度），并给出95%置信区间（CIs）。通过拟合混合两部分模型，包括对可能的混杂因素进行调整和重复测量，我们计算了索引日期后每4周的费用比率（CRs）。所有分析进一步按男性/女性、住院/门诊治疗以及严重/轻微骨盆骨折进行分层。
索引日期后的一年中，病例组的医疗利用率和平均费用高于对照组，住院治疗的差异尤为明显。费用比率（95% CIs）从最初4周内的10.7（10.2 - 11.1）降至第49 - 52周内的1.3（1.2 - 1.4）。住院患者的额外费用高于门诊治疗患者（第1 - 4周的费用比率分别为13.4（12.9 - 13.9）和2.3（2.0 - 2.6））。在最初几个月，严重和轻微骨盆骨折患者均出现高额额外费用。
骨盆骨折伴随着高额额外费用，在规划和分配医疗资源时应予以考虑。
