Inpatient hospital and post-acute care for vertebral fractures in women

Russel Burge, Elaine Puleo, Stephen Gehlbach, Dan Worley, Janelle Klar
Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research 2002, 5 (4): 301-11

OBJECTIVE: Approximately 700,000 vertebral fractures occur annually in the United States. Available estimates on hospital costs and length of stay for vertebral fractures do not reflect current practice patterns, nor has post-acute care utilization been reported in sufficient detail. This paper provides new estimates on acute care charges, length-of-stay (LOS), and distribution patterns of post-acute care for osteoporotic vertebral fractures in women aged 50 years and older in the United States.

METHODS: The Nationwide Inpatient Sample (NIS) database (1997) was used to identify admissions with a primary diagnosis of vertebral fracture. Decision rules based on clinical criteria were developed to identify vertebral fracture cases considered to be osteoporosis-related. Charges, LOS and discharge disposition were analyzed according to patient demographics and hospital characteristics.

RESULTS: In 1997, there were 53,066 hospital admissions for osteoporotic vertebral fractures in women. Mean charges and LOS were US 9,532 dollars and 6.2 days, respectively, while US totals were US 506 million dollars and 329,000 days. More than 40% were discharged to long-term care (LTC); another 24.3% required other follow-up care. Charges and LOS were inversely related to age. Female patients aged 75 or more were more than five times as likely to be discharged to LTC compared to women between the ages of 50 and 64. Charges and LOS were in general, significantly higher for patients in the Northeast, urban areas, teaching hospitals and in larger hospitals, and for patients transferred from other acute care hospitals.

CONCLUSIONS: Vertebral fractures are more expensive and resource-intensive than previously reported. Furthermore, total costs may be much greater when the components of post-acute care are fully captured.

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