Low-intensity pulsed ultrasound (LIPUS) can decrease the economic burden of fracture nonunion.

Abstract Objectives Few studies have evaluated the economic burden of surgical and conservative treatment of fracture nonunion. We undertook an analysis of aggregated payer data to determine economic costs of nonunions treated with surgery only v. nonunions treated conservatively with low-intensity pulsed ultrasound (LIPUS) only. Methods We used administrative claims from a health plan database including nearly 80 million people. Patients with a claim for nonunion surgery or LIPUS for nonunion were identified, from April 2007 until April 2010. A retrospective cohort was formed by pairwise demographic matching among patients who received "Surgery Only" or "LIPUS Only". Date of the first nonunion intervention (surgery or LIPUS) was defined as the index date. All medical costs were assessed over 12 months following the index date for the "Surgery Only" and "LIPUS Only" cohorts. Results A total of 1,158 matched patients were identified. "Surgery Only" patients used significantly more healthcare services. In the year following intervention, "Surgery Only" patients had total medical costs $6,289 higher than "LIPUS Only" patients (Mean: $11,276 vs. $4,987; p<0.0001). Outpatient costs accounted for >68% of overall costs in both cohorts, and outpatient costs were significantly higher among the "Surgery Only" cohort (Mean: $7,682 vs. $4,196; p<0.0001). Total inpatient costs were also significantly higher among the "Surgery Only" cohort (Mean: $3,302 vs $381; p<0.0001). Limitations Limitations of our work are typical of all studies based on administrative claims data: errors in the database are assumed to distribute randomly between cohorts and some patients may have been miscoded as to treatment received or costs billed. Conclusions "Surgery Only" patients used significantly and substantially more healthcare services in treatment of fracture nonunion. Conservative treatment with "LIPUS only" for fracture nonunion could potentially result in cost savings projected to $4 billion dollars annually in the United States.
KEYWORDS:
Health economics; aggregated payer data; surgery; ultrasound
PMID: 25708448