Excess healthcare spending associated with fractures among adults with cerebral palsy

Daniel G Whitney; Michelle S Caird; Karl J Jepsen; Edward A Hurvitz; Richard A Hirth

doi:10.1016/j.dhjo.2022.101315

Excess healthcare spending associated with fractures among adults with cerebral palsy

Disabil Health J. 2022 Jul;15(3):101315. doi: 10.1016/j.dhjo.2022.101315. Epub 2022 Mar 10.

Authors

Daniel G Whitney¹, Michelle S Caird², Karl J Jepsen², Edward A Hurvitz³, Richard A Hirth⁴

Affiliations

¹ Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA. Electronic address: dgwhit@med.umich.edu.
² Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.
³ Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, USA.
⁴ Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.

Abstract

Background: Fractures 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.

Objective: To identify short-term healthcare costs associated with fractures among adults with CP.

Methods: A 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.

Results: CP+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).

Conclusions: Fractures, 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.

Keywords: Cerebral palsy; Clinical epidemiology; Economic; Fracture; Healthcare costs.

Publication types

Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Adult
Cerebral Palsy* / complications
Disabled Persons*
Fractures, Bone* / complications
Health Care Costs
Humans
Retrospective Studies

Grants and funding

R01 AR076994/AR/NIAMS NIH HHS/United States