Excess healthcare spending associated with fractures among adults with cerebral palsy |
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| Affiliation: | 1. Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, USA;2. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA;3. Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA;4. Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA;5. Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA;1. Coaching and Teaching Studies, College of Physical Activity and Sport Sciences, West Virginia University, 375 Birch Street, P.O. Box 6116, Morgantown, WV 26505, USA;2. Health and Physical Education, Department of Human Movement Sciences, Old Dominion University, VA, USA;3. Center for Leadership in Disability, School of Public Health, Georgia State University, Atlanta, GA, USA;4. Community Health Academic Group, School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland;1. Research and Training Center on Disability in Rural Communities, University of Montana, USA;2. School of Physical Therapy and Rehabilitation Science, University of Montana, USA;1. Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI, 53705, USA;2. Lurie Institute for Disability Policy, Brandeis University, 415 South Street, MS 035, Waltham, MA, 02453, USA;3. Research and Evaluation Office, Boston Public Health Commission, 1010 Massachusetts Avenue, Boston, MA, 02118, USA;1. Ontario Tech University, Faculty of Health Sciences, 2000 Simcoe St N. Oshawa, ON, L1G 0C5, Canada;2. ICES, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada;3. University of Victoria, School of Exercise Science, Physical and Health Education, 3800 Finnerty Rd, Victoria, BC, V8P 5C2, Canada;4. SUNY Cortland, Department of Physical Education, P.O Box 2000, Cortland NY, 13045, USA;5. Centre for Addiction and Mental Health, 1001 Queen St. W., Toronto, ON, M6J 1H4, Canada |
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| Abstract: | BackgroundFractures represent a triple threat to adults with cerebral palsy (CP): common, accumulate early in adulthood, and are consequential to health. An economic evaluation of fractures in CP is needed to highlight priorities for allocating resources to clinical and public health programs aimed at preventing fractures and their disease sequela.ObjectiveTo identify short-term healthcare costs associated with fractures among adults with CP.MethodsA retrospective cohort study was performed using Optum's de-identified Clinformatics® Data Mart Database from 01/01/2011-12/31/2017. The primary cohort included adults ≥ 18 years old with CP with an incident fracture (CP+Fx), and cost estimates were compared with: CP without fractures (CPw/oFx) and without CP+Fx (w/oCP+Fx). A difference-in-difference (DiD) analysis compared the change in pharmacy and medical costs between cohorts from the one-year baseline period through the one-year post-index period in three-month quarters.ResultsCP+Fx (n = 855) had higher mean costs in the baseline and follow-up periods compared with CPw/oFx (n = 5667) and w/oCP+Fx (n = 588,042). The first post-index quarter DiD estimate suggests that CP+Fx accumulated an excess $6462 (95%CI = $3810-$9021) compared with w/oCP+Fx and $17,197 (95%CI = $14,418-$19,833) compared with CPw/oFx. The CP+Fx cohort had higher DiD estimates in the other follow-up quarters, but they were not statistically significant compared with CPw/oFx. When stratified by fracture site, vertebral column fractures for CP+Fx vs. w/oCP+Fx accumulated an excess $25,226 (95%CI = $12,639-$37,417).ConclusionsFractures, especially of the vertebral column, were associated with high healthcare costs among adults with CP. Studies are needed to identify cost-effective opportunities to utilize available resources to prevent fractures and their costly sequela for CP. |
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| Keywords: | Cerebral palsy Fracture Healthcare costs Economic Clinical epidemiology |
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