Risk Factors and Healthcare Costs Associated with Long Bone Fracture Non-Union – A US Claims Database Analysis

OBJECTIVES: Non-union is a common complication following long bone fractures, often requiring significant incremental healthcare resources. The payer cost of long bone non-union in patients with or without concurrent infection is not well documented. Our study evaluated 2-year incremental healthcare costs of non-union in patients with fractures.

METHODS: Patients within IBM® MarketScan® Commercial Claims and Encounters database with long bone (femur, humerus or tibia) fracture in the inpatient setting, and a surgical fracture repair procedure, from Q4 2015 to most recent, were identified. Exclusion criteria included: polytrauma and amputation at index. Outcomes: diagnosis of non-union in the 2-year post-index, concurrent infection, reoperation, and total healthcare costs. Variables: age, gender, comorbidities, fracture characteristics and severity. Descriptive analyses were performed on all three cohorts separately. Crude and adjusted rates of non-union (using Poisson regressions with log link) were calculated. Marginal, incremental cost of care associated with non-union, infection and reoperation, were estimated using a Generalized Linear Model (GLM) with log link and gamma distribution.

RESULTS: 12,770, 13,504 and 4,805 patients with surgically-treated femoral, tibial and humeral fractures were identified, respectively. Two-year post-index rates of non-union reached 8.5% (8.0%-9.1%) (femoral fracture), 9.1% (8.6%-9.7%) (tibial fracture), and 7.2% (6.4%-8.1%) in humeral fracture cases. Infected non-unions affected < 1% of femoral and humeral fractures, and 2% for tibial fractures. All tibial non-union patients were reoperated by 2 years, however only 71% of femoral non-unions, and 68% of humeral non-unions were already reoperated. The increased marginal cost of femoral, tibial and humeral non-union at 2-years post-index averaged $45,633 ($23,913-$67,352), $40,409 ($30,295-$50,523) and $33,308 ($14,603-$52,013), respectively, prior to reoperation and without concurrent infection. Reoperations added $16K-$34K incremental costs. When infection was also present, costs increased by $46K-$87K.

CONCLUSIONS: Non-union is associated with significant incremental costs. Without concurrent infection, non-union conditions add between $33K-$46K costs. Concurrent infection results in an additional $46K-$87K.