Abstract
Objectives
To assess the annual costs 2 years before and 2 years after a hospitalized fall-related
injury (HFRI) and the 2-year survival among the population 75+ years old.
Design
We performed a population-based, retrospective cohort study using the French national
health insurance claims database.
Setting and Participants
Patients 75+ years old who had experienced a fall followed by hospitalization, identified
using an algorithm based on International Classification of Diseases codes. Data related
to a non-HFRI population matched on the basis of age, sex, and geographical area were
also extracted.
Methods
Cost analyses were performed from a health insurance perspective and included direct
costs. Survival analyses were conducted using Kaplan-Meier curves and Cox regression.
Descriptive analyses of costs and regression modeling were carried out. Both regression
models for costs and on survival were adjusted for age, sex, and comorbidities.
Results
A total of 1495 patients with HFRI and 4484 non-HFRI patients were identified. Patients
with HFRI were more comorbid than the non-HFRI patients over the entire periods, particularly
in the year before and the year after the HFRI. Patients with HFRI have significantly
worse survival probabilities, with an adjusted 2.14-times greater risk of death over
2-year follow-up and heterogeneous effects determined by sex. The annual incremental
costs between patients with HFRI and non-HFRI individuals were €1294 and €2378, respectively,
2 and 1 year before the HFRI, and €11,796 and €1659, respectively, 1 and 2 years after
the HFRI. The main cost components differ according to the periods and are mainly
accounted for by paramedical acts, hospitalizations, and drug costs. When fully adjusted,
the year before the HFRI and the year after the HFRI are associated with increase
in costs.
Conclusions and Implications
We have provided real-world estimates of the cost and the survival associated with
patients with HFRI. Our results highlight the urgent need to manage patients with
HFRI at an early stage to reduce the significant mortality as well as substantial
additional cost management. Special attention must be paid to the fall-related increasing
drugs and to optimizing management of comorbidities.
Keywords
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Article info
Publication history
Published online: March 16, 2023
Publication stage
In Press Uncorrected ProofFootnotes
This work was supported by the Court of Auditors, a French public organization.
The authors declare no conflicts of interest.
Identification
Copyright
© 2023 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
