A population-based study of the direct longitudinal health care costs of upper extremity trauma in patients aged 18-65 years

Abstract

Background: Upper extremity (UE) trauma represents a common reason for emergency department visits, but the longitudinal economic burden of this public health issue is unknown. This study assessed the 3-year attributable health care use and expenditure after UE trauma requiring acute surgical intervention, with specific focus on injuries that affect function of the hand and wrist.

Methods: We conducted an incidence-based, propensity score-matched cohort study (2006-2014) in Ontario, Canada, using linked administrative health care data to identify case patients and matched control patients. We matched adults with hand, wrist and UE nerve trauma requiring surgery 1:4 to control patients. We compared total direct health care costs, including 1-year pre-index costs, between case and control patients using a differences-in-difference methodology. The primary outcome was attributable health care costs within 3 years of injury.

Results: We matched patients with trauma (n = 26 123) to noninjured patients (n = 104 353). Mean direct health care costs attributable to UE trauma were $9210 (95% confidence interval [CI] 8880 to 9550) within 3 years. Patients with trauma had significantly more emergency department visits (≥ 3 visits: 25% v. 12%; p < 0.001), mental health visits (34% v. 28%; p < 0.05) and secondary surgeries (25% v. 5%; p < 0.001). Specific patient populations had significantly greater attributable costs: patients requiring post-traumatic mental health visits ($11 360 v. $7090; p < 0.001), inpatient surgery ($14 060 v. $5940, p < 0.001) and complex injuries ($13 790 v. $7930; p < 0.001).

Interpretation: Health care expenditure increased more than fivefold in the year after UE trauma surgery and remained greater than the matched cohort for the subsequent 2 years. Those with more serious injuries and post-injury visits for mental health were associated with higher costs, requiring further study for this public health issue. The mean 1-year pre-injury and 1-year post-injury total costs were $1710 and $9350, respectively.