Economic burden of illness among US patients experiencing fracture nonunion

Ning Wu,¹ Yuan-chi Lee,¹ Daniel Segina,² Hallie Murray,³ Teresa Wilcox,¹ Luke Boulanger<sup>1

1</sup>United BioSource Corporation, Lexington, MA, USA; ²Department of Orthopaedics, Holmes Regional Trauma Center, Melbourne, FL, USA; ³Biomet Spine and Bone Healing Technologies, Parsippany, NJ, USA

Objectives: To compare economic outcomes in a real-world study of patients with fracture nonunion receiving non-invasive electrical bone growth stimulation (EBGS), low-intensity pulsed ultrasound stimulation (LIPUS), or other non-stimulation fracture management interventions (No-stim).
Methods: Medical and pharmacy claims from a US commercially-insured population were analyzed to select adult patients newly diagnosed with a fracture nonunion between July 2006 and September 2009. The date of initial nonunion diagnosis was set as the index date. Three cohorts were constructed based on the first treatment prescribed post index date: EBGS, LIPUS, or No-stim. Baseline demographics, clinical characteristics, and health care costs 9 months before and 1 year after the index date were assessed. Multivariate regression analyses were performed to compare health care costs between cohorts in the post index period.
Results: 11,628 patients (mean age 45.4 years; 45.7% males) with a fracture nonunion were identified within the three treatment groups (EBGS: 29.5%, LIPUS: 12.3%, and No-stim: 58.2%). In the post-index period, EBGS patients were significantly less likely to receive fracture-related treatments when compared to the LIPUS (33.6% vs 42.2%, P < 0.01) and the No-stim (33.6% vs 60.3%, P < 0.01) cohorts. Additionally, after adjusting for demographic and clinical characteristics, the EBGS cohort had significantly lower predicted health care-associated costs 1 year post index date when compared to the LIPUS (mean: $21,632 vs $23,964, P < 0.01) and the No-stim (mean: $21,632 vs $23,843, P < 0.01) cohorts. Furthermore, the predicted fracture-related costs (FRC) of EBGS patients were also significantly lower than the FRC of the LIPUS (mean: $9100 vs $10,255, P < 0.01) and the No-stim (mean: $9100 vs $10,354, P < 0.01) patients.
Conclusion: In a real-world setting, EBGS is a more cost-effective fracture nonunion treatment across a variety of fracture locations when compared to LIPUS or No-stim. Fracture nonunion patients receiving EBGS had lower total health care resource use and overall costs as compared to LIPUS or No-stim.

Keywords: electrical bone growth stimulation, low-intensity pulsed ultrasound stimulation, nonunion, fracture, health care utilization, economic burden