title: The direct and indirect costs of long bone fractures in a working age US population.
abstract: OBJECTIVE
  Information regarding the burden of fractures is limited, especially among working age patients. The objective of this study was to evaluate the direct and indirect costs associated with long bone fractures in a working age population using real-world claims data.
  
  
  METHODS
  This was a claims-based retrospective analysis, comparing adult patients in the 6 months before and 6 months after a long bone fracture between 1/1/2001 and 12/31/2008 using the MarketScan Research Databases. Outcomes included direct medical costs and utilization, as well as work absenteeism and short term disability, which was available for a sub-set of the patients. Observed and adjusted incremental costs (i.e., the difference in costs before and after a fracture) were evaluated and reported in 2008 US$.
  
  
  RESULTS
  A total of 208,094 patients with at least one fracture were included in the study. Six, mutually exclusive fracture cohorts were evaluated: tibia shaft (n = 49,839), radius (n = 97,585), hip (n = 11,585), femur (n = 6788), humerus (n = 29,884), and those with multiple long bone fractures (n = 12,413). Average unadjusted direct costs in the 6-months before a long bone fracture ranged from $3291 (radius) to $12,923 (hip). The average incremental direct cost increase in the 6-months following a fracture ranged from $5707 (radius) to $39,041 (multiple fractures). Incremental absenteeism costs ranged from $950 (radius) to $2600 (multiple fractures), while incremental short-term disability costs ranged from $2050 (radius) to $4600 (multiple fractures).
  
  
  CONCLUSIONS
  The results of this study indicate that long bone fractures are costly, both in terms of direct medical costs and lost productivity. Workplace absences and short-term disability represent a significant component of the burden of long bone fractures. These results may not be generalizable to all patients with fractures in the US, and do not reflect the burden of undiagnosed or sub-clinical fractures.
authors.affiliation: Truven Health Analytics, Cambridge, MA, USA. machaon.bonafede@truvenhealth.com
authors.forename: Machaon
authors.initials: M
authors.lastname: Bonafede
authors.forename: Derek
authors.initials: D
authors.lastname: Espindle
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Bower
mesh_terms: D000041:Absenteeism; D000328:Adult; D000367:Age Factors; D015897:Comorbidity; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D004185:Disability Evaluation; D005260:Female; D050723:Fractures, Bone / Q000145:classification* / Q000191:economics*; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000145:classification / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors; D014481:United States / Q000453:epidemiology