Venue: The Fuqua School of Business, Duke University, 1 Towerview Drive, Durham, NC 27708-0120
Presentation
Medical Cost of Osteoporosis in the Elderly Medicare Population
BACKGROUND: Osteoporotic fractures and treatment impose a large burden on the U.S. medical system. Past estimates of national cost have relied on multiple sets of provider data or claims data of non-random samples of commerical insurers. We sought to characterize prevalence and costs for osetoporosis using a recent population-based sample of elderly U.S. Medicare recipients.
METHODS: A cross-sectional estimate of medical cost was made with 2002 claims and survey data from the Medicare Current Beneficiary Survey (MCBS). MCBS combines health interviews with administrative claims information from both public and private payers to profile a representative sample of Medicare recipients. Three cohorts aged 65 or over were defined: 1) patients experiencing a fracture-related claim in 2002, 2) patients with a diagnosis, medication, or self-report for osteoporosis, or self-reported past hip fracture, and 3) individuals with none of these factors (controls). One cost estimate was the costs of claims coded with a fracture or disease-related diagnosis, procedure, or medication. The other was the total cost of all patient claims compared to that of controls using regression models adjusting for age, gender, comorbidities, and institutionalization. Projections and standard errors for the national Medicare population were calculated using MCBS-provided weights for the stratified multistage sample design.
RESULTS: Of 30.2 million elderly Medicare recipients in 2002, 1.6 million (5%) were treated for a fracture that year and an additional 7.2 million (24%) have osteoporosis without a fracture. Fracture-coded claims in 2002 averaged $4400 per fracture patient, 33% of whom had hip fractures (mean cost $9,600) and 15% of whom had spine fractures (mean cost $2400). Mean unadjusted total expense for each fracture patient was $27,700, $19,200 more than the $8,500 expense of controls. After multivariate adjustment with a linear regression model, the average marginal impact of fracture on annual total cost was $8600 (95%CI: $6400, $10,800). Results were robust with respect to alternate regression models (log-linear and a generalized linear model with a log-link (Poisson distribution)). Extrapolating to the U.S. elderly population, expenditures for fractures were $10 to $17 billion in 2002. Fewer than half (47%) of the non-fracture osteoporosis patients received drug treatment, averaging $500 per treated patient, or $2 billion nationwide. The mean estimate inflated to 2006 is estimated at $19 billion. Almost 70% of the fracture and osteoporosis expenses were borne by Medicare, 4% by Medicaid, 17% by supplemental insurers, and 10% by the patients.
CONCLUSION: The study estimate of $19 billion in 2006 corroborates previous estimates of the sizeable medical cost of osteoporosis (ranging from $10 to $22 billion), though it used a substantially different data source and methodology.