A comparison of the case-control and case-crossover designs for estimating medical costs of nonfatal fall-related injuries among older Americans.

Journal Article (Journal Article)


Although the case-crossover design has been used widely in epidemiological and cost-offset studies as an alternative to the case-control design, it is rarely applied to cost-of-illness studies. In this study, costs for a series of hospitalized and nonhospitalized fall-related injuries were computed using the 2 approaches to allow for a direct comparison of the results.

Research design

We used claims data from the Medicare fee-for-service 5% Standard Analytical Files. For the case-control design, those who sustained nonfatal fall-related injuries were tracked for 1 year after their first fall, and costs were compared, using regression analysis, to annual costs for a comparison sample of nonfallers. The case-crossover design used a modified regression approach that compared monthly costs of fallers before and after fall.


We present unit costs for falls requiring (1) a hospitalization resulting in a live discharge, (2) an emergency department visit not resulting in an admission, and (3) falls requiring office-based or hospital outpatient visits only. Using the case-control design, these costs were $22,260, $3890, and $5040 respectively. Using the case-crossover design, these estimates were reduced to $20,920, $3230, and $4200.


On average, estimates of the costs of fall injuries from the case-control design were between 6% and 17% greater than those from the case-crossover approach. These differences likely result from our inability to control for comorbidity differences between fallers and nonfallers in the case-control design. Under several scenarios, including unobserved heterogeneity between cases and controls, the case-crossover design, although computationally more intensive, produces more accurate results.

Full Text

Duke Authors

Cited Authors

  • Finkelstein, EA; Chen, H; Miller, TR; Corso, PS; Stevens, JA

Published Date

  • November 2005

Published In

Volume / Issue

  • 43 / 11

Start / End Page

  • 1087 - 1091

PubMed ID

  • 16224301

Electronic International Standard Serial Number (EISSN)

  • 1537-1948

International Standard Serial Number (ISSN)

  • 0025-7079

Digital Object Identifier (DOI)

  • 10.1097/01.mlr.0000182513.35595.60


  • eng