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

Publication ,  Journal Article
Finkelstein, EA; Chen, H; Miller, TR; Corso, PS; Stevens, JA
Published in: Med Care
November 2005

OBJECTIVES: 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. RESULTS: 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. CONCLUSIONS: 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.

Duke Scholars

Published In

Med Care

DOI

ISSN

0025-7079

Publication Date

November 2005

Volume

43

Issue

11

Start / End Page

1087 / 1091

Location

United States

Related Subject Headings

  • Wounds and Injuries
  • United States
  • Regression Analysis
  • Medicare
  • Male
  • Humans
  • Hospitalization
  • Health Policy & Services
  • Health Expenditures
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Finkelstein, E. A., Chen, H., Miller, T. R., Corso, P. S., & Stevens, J. A. (2005). A comparison of the case-control and case-crossover designs for estimating medical costs of nonfatal fall-related injuries among older Americans. Med Care, 43(11), 1087–1091. https://doi.org/10.1097/01.mlr.0000182513.35595.60
Finkelstein, Eric A., Hong Chen, Ted R. Miller, Phaedra S. Corso, and Judy A. Stevens. “A comparison of the case-control and case-crossover designs for estimating medical costs of nonfatal fall-related injuries among older Americans.Med Care 43, no. 11 (November 2005): 1087–91. https://doi.org/10.1097/01.mlr.0000182513.35595.60.
Finkelstein, Eric A., et al. “A comparison of the case-control and case-crossover designs for estimating medical costs of nonfatal fall-related injuries among older Americans.Med Care, vol. 43, no. 11, Nov. 2005, pp. 1087–91. Pubmed, doi:10.1097/01.mlr.0000182513.35595.60.

Published In

Med Care

DOI

ISSN

0025-7079

Publication Date

November 2005

Volume

43

Issue

11

Start / End Page

1087 / 1091

Location

United States

Related Subject Headings

  • Wounds and Injuries
  • United States
  • Regression Analysis
  • Medicare
  • Male
  • Humans
  • Hospitalization
  • Health Policy & Services
  • Health Expenditures
  • Female