• Samir Mehta, Ken Long, Mitch DeKoven, Elise Smith, and R Grant Steen.
• Department of Orthopaedic Surgery, University of Pennsylvania , Philadelphia, PA , USA.
• J Med Econ. 2015 Jan 1; 18 (7): 542-9.

ObjectivesFew studies have evaluated the economic burden of surgical and conservative treatment of fracture non-union. An analysis was undertaken of aggregated payer data to determine economic costs of non-unions treated with surgery only vs non-unions treated conservatively with low-intensity pulsed ultrasound (LIPUS) only.MethodsThis study used administrative claims from a health plan database including nearly 80 million people. Patients with a claim for non-union surgery or LIPUS for non-union 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 non-union 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.ResultsA total of 1158 matched patients were identified. 'Surgery Only' patients used significantly more healthcare services. In the year following intervention, 'Surgery Only' patients had total medical costs $6289 higher than 'LIPUS Only' patients (Mean = $11,276 vs $4986; 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 = $7682 vs $4196; p < 0.0001). Total inpatient costs were also significantly higher among the 'Surgery Only' cohort (Mean = $3302 vs $381; p < 0.0001).LimitationsLimitations of this 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 non-union. Conservative treatment with 'LIPUS only' for fracture non-union could potentially result in cost savings projected to roughly $1 billion dollars [corrected].

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