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A 5-Year Longitudinal Retrospective Cohort Study of Health Care Use and Costs Before and After Incident Traumatic
Paul Lin1, Adit Doza2, Zoe C Gurney2
1Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI.
Objective:
To examine trends in health care use and cost before and after incident traumatic spinal cord injury (TSCI) in the United States.
Design:
Retrospective cohort study.
Setting:
Using 2012-2019 claims data from the Health Care Cost Institute, we identified adults (45+) with a diagnosis of incident TSCI (n=251). Using age, sex, and a set of chronic conditions, we matched 2480 adults without TSCI (controls) with our cases. Health care use and costs were analyzed for cases and controls for 5 years. We used 2-part generalized estimating equations to predict any health care use/costs and positive use/costs in inpatient, outpatient, professional, and prescription drug settings, as well as total and out-of-pocket health care costs.
Participants:
Adults with and without TSCI.
Intervention:
Not applicable.
Main Outcomes Measures:
Health care use and costs.
Results:
Incident TSCI was associated with an increase in total and out-of-pocket costs of health care (excluding the month of injury) during the first year of injury compared with the matched controls by odds ratio=7.72 (95% CI: 5.86, 10.16) and odds ratio=2.02 (95% CI: 1.59, 2.55), respectively. Higher costs were mainly attributed to inpatient ($55,494; 95% CI: $40,230, $76,549) and professional services ($17,973; 95% CI: $13,525, $23,885). TSCI was associated with a decrease in health care costs in the 3 years after the incident but was also associated with higher costs than those of controls. TSCI was associated with an increase in the number of outpatient (7.44-9.01) and inpatient services (1.25-1.96) during the fifth year. Health care use and costs remained stable among controls throughout the 5-year study period.
Conclusions:
TSCI was associated with a higher total and out-of-pocket cost of health care in the year of incident compared with controls. After the first year, the associated costs of TSCI sharply declined but remained slightly higher than those of controls.
