Method Comparison and Cost Estimation of the Healthcare Economic Burden of Older Adult Falls: A State Specific Perspective Open Access

Haddad, Yara (2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/hx11xg030?locale=en
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Abstract

ABSTRACT Title: Method Comparison and Cost Estimation of The Healthcare Economic Burden of Older Adult Falls: A State Specific Perspective By Yara K. Haddad, PharmD Introduction: Unintentional falls in older adults impose a significant economic burden on the health care system. Previous studies estimated the direct medical costs for falls at the national level; however, state level economic estimates are limited. This study compares two methods to estimate state level direct medical costs of falls in older adults. Methods: In the partial attributable fraction method, the total personal health expenditure was obtained by state of residence from publically available National Health Expenditure Accounts (NHEA) categorized by payer type. The percentage of total spending by payer for older adults was obtained from age-gender files in NHEA to estimate payer expenditure for older adults by state. Then, the proportion of national spending attributable to older adult falls was applied to estimate the total health expenditure for older adult falls per state and payer. All payer expenditures were totaled to calculate state expenditure attributable to older adult falls. In the count applied to cost method, counts of older adults hospitalized and treated in emergency department (ED) due to fall injury were obtained from the Healthcare Cost and Utilization Project (HCUP) using injury diagnosis and external causes of injury codes. The counts were multiplied by the average lifetime medical cost of treatment for ED treated and hospitalized older adult falls from the Web-based Injury Statistics Query and Reporting System (WISQARS). The two costs associated with hospitalization and ED visits were totaled for available states. All costs were indexed to 2012 US-dollars. Results: The count applied to cost estimates of direct medical costs due to falls were lower compared with the partial attributable fraction method. Conclusion: The methods highlighted offer states a way to estimate the economic burden of older adult falls per year. The difference in cost estimates can be attributed to different cost categories used to calculate the direct medical costs. The partial attributable fraction method captures a more comprehensive cost estimate of all associated healthcare costs and displays the proportion of cost by each of the three major payers –Medicaid, Medicare and Private Insurance. The count applied to cost method allows for quick estimates per state generated hospitalization and ED records. Word count: 350

Table of Contents

TABLE OF CONTENTS 1. Introduction 1 1.1 Background 1 1.2 Epidemiology of Older Adult Falls 1 1.3 Older Adult Fall Risk Factors 2 1.4 Economic Burden of Older Adult Falls 2 1.5 Study aims 3 2. Literature review 4 2.1 Background 4 2.2 National Cost Estimation of Falls 5 2.3 State Cost Estimation of Falls 8 2.4 Conclusion 10 3. Student Contributions 11 3.1 Student Contribution to Project 11 3.2 Intended Journal for Publication 11 3.3 International Review Board Exemption 12 4. Public Health Implications 13 5. Manuscript 15 6. APPENDIX 26 Table 1: Medicare total personal healthcare spending attributable to older adult falls by state, US, 2012 26 Table 2: Medicaid total personal healthcare spending attributable to older adult falls by state, US, 2012. 28 Table 3: Private Insurance total personal healthcare spending attributable to older adult falls by state, US, 2012 30 Table 4: All payer healthcare spending per state attributable to older adult falls, US, 2012 32 Table 5: Hospitalization cost for older adult fall injuries per state, US, 2012 33 Table 6: Emergency department treated and released costs for older adult fall injuries per state, US, 2012 34 Table 7: Comparison of two methods of estimating state level medical costs for older adult falls, US, 2012 35 Figure 1: IRB 36 References 37

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