Raats J H, Chang Y, Brameier D T, Ponds N, Weaver M J
Department of Orthopaedic Trauma, Brigham and Women's Hospital, Boston, Massachusetts.
St. Antonius Hospital, Utrecht, The Netherlands.
J Bone Joint Surg Am. 2025 Apr 2;107(7):717-724. doi: 10.2106/JBJS.24.00544. Epub 2025 Feb 19.
Increasing U.S. health-care costs raise concerns regarding the sustainability of the U.S. health-care system, with the potential for negative effects on the mental and physical health of patients. Orthopaedic injuries often impose considerable financial burdens on patients and hospitals, but the trends in, and drivers of, costs remain unclear. This study evaluated the total expenditure and out-of-pocket (OOP) costs of patients with a lower-extremity (LE) fracture in the non-institutionalized U.S. population from 2010 to 2021.
A total of 3,016 participants with an LE fracture from the Medical Expenditure Panel Survey (MEPS) were propensity score matched with 15,080 MEPS participants with no LE fracture. Patients with an LE fracture were predominantly between 40 and 64 years old (43.2%), female (66.0%), and White (78.8%). Total expenditure and OOP costs were compared between the groups. A multivariable regression analysis was performed to identify factors that were associated with costs. Outcomes were adjusted on the basis of the 2022 Consumer Price Index.
Patients with an LE fracture had greater total expenses than the control group ($20,230 [95% confidence interval (CI), $18,916 to $21,543] versus $10,678 [95% CI, $10,302 to $11,053]; p < 0.001) as well as greater OOP costs ($1,634 [95% CI, $1,516 to $1,753] versus $1,089 [95% CI, $1,050 to $1,128]; p < 0.001). Between 2010 and 2021, total expenses increased more for patients with an LE fracture than for the control group (101.2% versus 51.4%; p < 0.001), whereas OOP costs increased to a lesser degree in both groups (61.1% versus 44.5%; p = 0.17). In the LE fracture group, total expenditure was driven by inpatient care, office-based visits, and prescription costs, whereas OOP costs were driven by office-based visits, prescription costs, and "other" sources. Femoral fracture, hospitalization, and certain comorbidities were associated with higher total expenses. Hospitalization, uninsured status, and a higher income level were associated with increased OOP costs, whereas African American or Hispanic background and a lower educational level were associated with lower OOP costs.
An LE fracture was associated with considerable total expenditure and OOP costs, which increased disproportionately compared with general health-care costs over the past decade. Post-hospitalization care was the biggest driver of both total expenses and OOP costs. Due to limitations inherent to the MEPS database, the impact of financial burden on not only payers but also individuals and their medical decision-making remains unclear and requires further investigation.
Economic Level III . See Instructions for Authors for a complete description of levels of evidence.
美国医疗保健成本不断上升引发了对美国医疗保健系统可持续性的担忧，这可能对患者的身心健康产生负面影响。骨科损伤常常给患者和医院带来相当大的经济负担，但成本的趋势和驱动因素仍不明确。本研究评估了2010年至2021年美国非机构化人群中下肢（LE）骨折患者的总支出和自付费用。
来自医疗支出面板调查（MEPS）的3016名LE骨折参与者与15080名无LE骨折的MEPS参与者进行倾向得分匹配。LE骨折患者主要年龄在40至64岁之间（43.2%），女性（66.0%），白人（78.8%）。比较了两组之间的总支出和自付费用。进行多变量回归分析以确定与成本相关的因素。结果根据2022年消费者价格指数进行了调整。
LE骨折患者的总费用高于对照组（20230美元[95%置信区间（CI），18916美元至21543美元]对10678美元[95%CI，10302美元至11053美元]；p<0.001），自付费用也更高（1634美元[95%CI，1516美元至1753美元]对1089美元[95%CI，1050美元至1128美元]；p<0.001）。2010年至2021年期间，LE骨折患者的总费用增长幅度大于对照组（101.2%对51.4%；p<0.001），而两组的自付费用增长幅度较小（61.1%对44.5%；p = 0.17）。在LE骨折组中，总支出由住院治疗、门诊就诊和处方费用驱动，而自付费用由门诊就诊、处方费用和“其他”来源驱动。股骨骨折、住院治疗和某些合并症与更高的总费用相关。住院治疗、未参保状态和较高的收入水平与自付费用增加相关，而非洲裔美国人或西班牙裔背景以及较低的教育水平与较低的自付费用相关。
LE骨折与相当大的总支出和自付费用相关，在过去十年中，与一般医疗保健成本相比，其增长不成比例。出院后护理是总费用和自付费用的最大驱动因素。由于MEPS数据库固有的局限性，财务负担不仅对支付方，而且对个人及其医疗决策的影响仍不明确，需要进一步调查。
经济水平III。有关证据水平的完整描述，请参阅作者指南。
