IDEAS home Printed from
   My bibliography  Save this article

Fall/Fracture-Related Healthcare Costs and Their Association with Cumulative Anticholinergic Burden in People with Overactive Bladder


  • Greta Lozano-Ortega

    (Broadstreet Health Economics and Outcomes Research)

  • Carol R. Schermer

    (Astellas Pharmaceutical Global Development Inc.)

  • David R. Walker

    (Astellas Pharmaceutical Global Development Inc.)

  • Shelagh M. Szabo

    (Broadstreet Health Economics and Outcomes Research)

  • Basia Rogula

    (Broadstreet Health Economics and Outcomes Research)

  • Alison M. Deighton

    (Broadstreet Health Economics and Outcomes Research)

  • Katherine L. Gooch

    (Astellas Pharmaceutical Global Development Inc.)

  • Noll L. Campbell

    (Purdue University)


Background Falls/fractures are major causes of morbidity and mortality among older adults and the resulting health consequences generate a substantial economic burden. Risk factors are numerous and include overactive bladder (OAB) and anticholinergic use. Objectives We aimed to estimate the impact of falls/fractures on all-cause healthcare resource utilization and costs, according to levels of cumulative anticholinergic burden, among individuals with OAB. Methods Among a US cohort of adults with OAB (identified based on medical claims for OAB or OAB-specific medications), the frequency of resource utilization (outpatients visits, medication use, and hospitalizations) was examined according to level of anticholinergic burden. Anticholinergic burden was assessed cumulatively using a published measure, and categorized as no, low, medium, or high. Resource utilization prior to and after a fall/fracture was compared. Generalized linear models were used to examine overall and incremental changes in healthcare resource utilization and costs by fall/fracture status, and annual costs were predicted according to age, sex, fall/fracture status, and level of anticholinergic burden. Results The mean age of the OAB cohort (n = 154,432) was 56 years, 68% were female, and baseline mean anticholinergic burden was 266.7 (i.e. a medium level of burden); a fall/fracture was experienced by 9.9% of the cohort. All estimates of resource utilization were higher among those with higher levels of anticholinergic burden, regardless of fall/fracture status, and higher for all levels of anticholinergic burden after a fall/fracture. Among those with a fall/fracture, the highest predicted annual costs were observed among those aged 66–75 years with high anticholinergic burden (US$22,408 for males, US$22,752 for females). Conclusions Falls/fractures were associated with higher costs, which increased with increasing anticholinergic burden.

Suggested Citation

  • Greta Lozano-Ortega & Carol R. Schermer & David R. Walker & Shelagh M. Szabo & Basia Rogula & Alison M. Deighton & Katherine L. Gooch & Noll L. Campbell, 2021. "Fall/Fracture-Related Healthcare Costs and Their Association with Cumulative Anticholinergic Burden in People with Overactive Bladder," PharmacoEconomics - Open, Springer, vol. 5(1), pages 45-55, March.
  • Handle: RePEc:spr:pharmo:v:5:y:2021:i:1:d:10.1007_s41669-020-00215-w
    DOI: 10.1007/s41669-020-00215-w

    Download full text from publisher

    File URL:
    File Function: Abstract
    Download Restriction: no

    File URL:
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item

    References listed on IDEAS

    1. Anirban Basu & Willard G. Manning & John Mullahy, 2004. "Comparing alternative models: log vs Cox proportional hazard?," Health Economics, John Wiley & Sons, Ltd., vol. 13(8), pages 749-765, August.
    Full references (including those not matched with items on IDEAS)


    Blog mentions

    As found by, the blog aggregator for Economics research:
    1. Journal round-up: PharmacoEconomics – Open 5(1)
      by Rita Faria in The Academic Health Economists' Blog on 2021-04-29 06:00:05

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Joseph F. Levy & Marjorie A. Rosenberg, 2019. "A Latent Class Approach to Modeling Trajectories of Health Care Cost in Pediatric Cystic Fibrosis," Medical Decision Making, , vol. 39(5), pages 593-604, July.
    2. Mandy Ryan & Emmanouil Mentzakis & Catriona Matheson & Christine Bond, 2020. "Survey modes comparison in contingent valuation: Internet panels and mail surveys," Health Economics, John Wiley & Sons, Ltd., vol. 29(2), pages 234-242, February.
    3. Manning, Willard G. & Basu, Anirban & Mullahy, John, 2005. "Generalized modeling approaches to risk adjustment of skewed outcomes data," Journal of Health Economics, Elsevier, vol. 24(3), pages 465-488, May.
    4. Thompson, Simon G. & Nixon, Richard M. & Grieve, Richard, 2006. "Addressing the issues that arise in analysing multicentre cost data, with application to a multinational study," Journal of Health Economics, Elsevier, vol. 25(6), pages 1015-1028, November.
    5. Anirban Basu & James J. Heckman & Salvador Navarro-Lozano & Sergio Urzua, 2007. "Use of instrumental variables in the presence of heterogeneity and self-selection: an application to treatments of breast cancer patients," Health Economics, John Wiley & Sons, Ltd., vol. 16(11), pages 1133-1157.
    6. Law, Michael R. & Grépin, Karen A., 2010. "Is newer always better? Re-evaluating the benefits of newer pharmaceuticals," Journal of Health Economics, Elsevier, vol. 29(5), pages 743-750, September.
    7. John Mullahy, 2015. "In Memoriam: Willard G. Manning, 1946‐2014," Health Economics, John Wiley & Sons, Ltd., vol. 24(3), pages 253-257, March.
    8. Stargardt, Tom & Schreyögg, Jonas, 2012. "A framework to evaluate the effects of small area variations in healthcare infrastructure on diagnostics and patient outcomes of rare diseases based on administrative data," Health Policy, Elsevier, vol. 105(2), pages 110-118.
    9. Manos Matsaganis & Theodore Mitrakos & Panos Tsakloglou, 2008. "Modelling Household Expenditure on Health Care in Greece," Working Papers 68, Bank of Greece.
    10. Smith, William C. & Anderson, Emily & Salinas, Daniel & Horvatek, Renata & Baker, David P., 2015. "A meta-analysis of education effects on chronic disease: The causal dynamics of the Population Education Transition Curve," Social Science & Medicine, Elsevier, vol. 127(C), pages 29-40.
    11. Jones, A. & Lomas, J. & Rice, N., 2014. "Going Beyond the Mean in Healthcare Cost Regressions: a Comparison of Methods for Estimating the Full Conditional Distribution," Health, Econometrics and Data Group (HEDG) Working Papers 14/26, HEDG, c/o Department of Economics, University of York.
    12. Manos Matsaganis & Theodore Mitrakos & Panos Tsakloglou, 2009. "Modelling health expenditure at the household level in Greece," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 10(3), pages 329-336, July.
    13. Kasteridis, Panagiotis & Rice, Nigel & Santos, Rita, 2022. "Heterogeneity in end of life health care expenditure trajectory profiles," Journal of Economic Behavior & Organization, Elsevier, vol. 204(C), pages 221-251.
    14. Amal Malehi & Fatemeh Pourmotahari & Kambiz Angali, 2015. "Statistical models for the analysis of skewed healthcare cost data: a simulation study," Health Economics Review, Springer, vol. 5(1), pages 1-16, December.
    15. Andrei Barbos & Yi Deng, 2015. "The Impact Of A Public Option In The U.S. Health Insurance Market," Economic Inquiry, Western Economic Association International, vol. 53(1), pages 508-521, January.
    16. Noémi Kreif & Richard Grieve & M. Zia Sadique, 2013. "Statistical Methods For Cost‐Effectiveness Analyses That Use Observational Data: A Critical Appraisal Tool And Review Of Current Practice," Health Economics, John Wiley & Sons, Ltd., vol. 22(4), pages 486-500, April.
    17. Gaskin, Darrell J. & Zare, Hossein & Delarmente, Benjo A., 2021. "Geographic disparities in COVID-19 infections and deaths: The role of transportation," Transport Policy, Elsevier, vol. 102(C), pages 35-46.
    18. Jones, A.M, 2010. "Models For Health Care," Health, Econometrics and Data Group (HEDG) Working Papers 10/01, HEDG, c/o Department of Economics, University of York.
    19. Vibeke Müller & Ulf Gerdtham & Ann Alriksson‐Schmidt & Johan Jarl, 2022. "Parental decisions to divorce and have additional children among families with children with cerebral palsy: Evidence from Swedish longitudinal and administrative data," Health Economics, John Wiley & Sons, Ltd., vol. 31(10), pages 2170-2186, October.
    20. Tatiana Dilla & Amparo Valladares & Claudia Nicolay & Javier Salvador & Jesús Reviriego & María Costi, 2012. "Healthcare Costs Associated with Change in Body Mass Index in Patients with Type 2 Diabetes Mellitus in Spain," Applied Health Economics and Health Policy, Springer, vol. 10(6), pages 417-430, November.

    More about this item


    Access and download statistics


    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:pharmo:v:5:y:2021:i:1:d:10.1007_s41669-020-00215-w. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.