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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