A Comparison of the Case???Control and Case???Crossover Designs for Estimating Medical Costs of Nonfatal Fall-Related Injuries Among Older Americans

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

Clinical study design · Clinical trial · Crossover study · Emergency department · Poison control · Psychiatry · Research design · Statistics · Balance, Gait, and Falls Prevention · Emergency Medicine · Frailty in Older Adults · Health Systems, Economic Evaluations, Quality of Life · Mathematics · Medicine

• Medical Costs of Fatal and Nonfatal Falls in Older Adults

  Open Access•Curtis Florence, Curtis S Florence et al.•Journal of the American…•2018

  Add to list

• Claims-based Identification Methods and the Cost of Fall-related Injuries Among US Older Adults

  Geoffrey J Hoffman, Ron D Hays et al.•Medical Care•2016

  Add to list

• Comorbidity Measures for Use with Administrative Data

  Anne Elixhauser, Claudia Steiner et al.•Medical Care•1998

  Add to list

• Health Care Utilization and Costs in a Medicare Population by Fall Status

  John A Rizzo, Rebecca Friedkin et al.•Medical Care•1998

  Add to list