Abstract
Objectives: Diabetic patients can suffer from poor bone quality and impaired vascularity often leading to increased fracture risk, delayed healing and potential fracture nonunion. Therefore, this study assessed healthcare resource utilization by diabetic patients receiving electrical bone growth stimulation (EBGS) versus Low-intensity Pulsed Ultrasound Stimulation (LIPUS) or neither (No-stim) for the management of their fracture nonunions. Methods: Diabetic and non-diabetic patients newly diagnosed with a fracture nonunion were identified using medical and pharmacy claims and stratified by the first treatment received after nonunion diagnosis: EBGS, LIPUS, or No-stim. Patient demographics, comorbidities, fracture characteristics, and healthcare costs were analyzed before and after nonunion diagnosis. Multivariate regression analysis was used to compare healthcare costs incurred during nonunion fracture management for the different treatment cohorts. Results: After controlling for demographic and clinical characteristics in the diabetic group, EBGS was associated with significantly lower total healthcare costs when compared with the No-stim cohort (marginal difference: -$11,834, p<0.01) and significantly lower fracture-related costs when compared to both the LIPUS (marginal difference: -$3,016, p=0.02) and the No-stim (marginal difference: -$4,783, p<0.01) cohorts. LIPUS was associated with significantly lower total healthcare costs (marginal difference: -$8,743, p=0.01), but similar fracture-related costs (marginal difference: -$1,767, p=0.23) when compared to the No-stim cohort. In the non-diabetic group a similar trend was observed as EBGS was associated with significantly lower costs when compared to the other cohorts. Conclusions: Study results suggest that EBGS is associated with lower healthcare costs in the management of fracture nonunions in both diabetic and non-diabetic patients.
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