Updated Healthcare Cost Estimates of Fall-Related Injuries Among Older Adults

Existing fall-related injury (FRI) cost estimates are dated, inconsistent (ranging from $2,000 to $26,000) and non-generalizable to the U.S., community-dwelling Medicare fee-for-service population.

Using 2007-09 Medicare claims from multiple care settings and linked 2008 Health and Retirement Survey data, FRIs were identified using an adapted UCLA-RAND algorithm with inpatient ICD-9 diagnostic and e-codes (880/881/882/883/884/885/886/888) and a similar algorithm additionally including outpatient diagnostic and CPT codes for procedures and imaging. An FRI cohort included those with a 2008 FRI and no FRIs in the prior, rolling 12-month period. Non-FRI cohort individuals were given a 7/1/2008 index date. The difference in cost changes (post-index minus pre-index costs) between cohorts was estimated to isolate FRI costs. Linear regression models adjusted for sociodemographic characteristics, health status, and geographic factors were specified.

5,548 community-dwelling adults ≥65 (103 FRI and 5,445 non-FRI cohort individuals with continuous Medicare Parts A/B coverage and alive during the 24-month study period.

Unadjusted medical costs during follow-up were $23,429 and $9,818 for FRI and non-FRI cohorts. Adjusted costs for FRIs treated in ED/hospital settings were $14,878 ($6,078 inpatient, $2,644 outpatient/carrier, $5,036 SNF, $1,112 home health) and $11,678 for those treated in inpatient and/or outpatient settings. FRIs increased the risk of high costs in the 4 post-index quarters.

FRIs were associated with substantial and sustained increases in Medicare spending. With roughly 3 million annual FRIs at an approximate additional cost of $12,000-15,000/FRI, estimated Medicare costs due to FRIs were estimated at $45-60 billion.