Fragility fracture-related direct medical costs in the first year following a nonvertebral fracture in a managed care setting.

The objective of this study was to estimate the fracture-related direct medical costs during the first year following a fragility nonvertebral fracture in a managed care setting. This was a retrospective cohort study conducted among patients (aged 45+ years) with a primary diagnosis for a fragility nonvertebral fracture between July 1, 2000, and December 31, 2000, using MarketScan, an integrated administrative, medical, and pharmacy claims database. All patients had 6 months of observation prior to their fracture and 12 months following a nonvertebral fracture. Fracture-related direct medical costs were evaluated in the 12-month period following fracture diagnosis using 2003 Medicare fee schedule payments. The costs per fracture per year (PFPY) for specific nonvertebral fracture sites were determined, as well as costs by type of care (i.e., outpatient, inpatient, and other). A total of 4,477 women and men fulfilled the inclusion criteria. The sample was comprised of 73% women and the mean age was 70 years. The most prevalent nonvertebral fracture sites were wrist/forearm (37%), hip (25%), and humerus (15%). Mean total costs per patient per year were highest for fractures of the hip ($26,856), femur ($14,805), tibia ($10,224), and pelvis ($10,198). On average, 84% of the annual fracture-related costs were inpatient; 3% were outpatient, and 13% were long-term care and other costs. In a patient population aged 45+ years, the first month following a nonvertebral fracture has a major impact on medical care costs. The most costly nonvertebral fracture sites were hip, femur, and tibia fractures.