Fractures, Other Skeletal Issues Lead to High Postdischarge Costs in Patients With MM, Bone Metastases

Most patients with bone metastases or multiple myeloma (MM) who are hospitalized with skeletal-related events require lengthy and costly follow-up care after they are discharged.

The large majority of patients who are hospitalized with skeletal-related events (SREs) due to bone metastases or multiple myeloma (MM) need health care facility support after discharge, and the costs of such care drives up health care spending significantly, according to a new study.

SREs are defined as bone fractures, spinal cord compression, and radiation or surgery to the bone. They can be a serious and common complication for people with bone metastases from solid tumors, a category of cancer that affects some 330,000 adults in the United States. MM can similarly cause significant rates of SREs. MM affects an estimated 130,000 people.

Although the risks and costs of SREs are well-documented, the posthospitalization cost and status of patients are not as well-studied, according to corresponding author Suying Li, PhD, of the Hennepin Healthcare Research Institute, and colleagues.

The investigators decided to attempt to quantify the cost of postdischarge care for patients with SREs. They pulled data from a random 20% sample of fee-for-service Medicare beneficiaries from the years 2011 to 2015. The data set included enrollment information, demographics, and claims from parts A, B, and D of Medicare.

More than 12,000 patients were identified who had an SRE-related hospital discharge during the time period studied. The patients were split into 2 cohorts based on their cancer type: 7988 patients had bone metastases from solid tumors and 4277 patients had MM. The patients had mean ages of 76.9 and 76.6 years, respectively. Li and colleagues’ analysis of these patients was published in the Journal of Bone Oncology.

About three-quarters of elderly patients needed health care facility support after they were released from the hospital. Among patients with bone metastases, 32.9% of patients were sent to skilled nursing facilities (SNFs) upon discharge, 13.7% received care from home health agencies (HHAs), and 13.5% were referred to hospice care. Another 11.3% moved to long-term care (LTC) facilities.

In the MM cohort, 35.9% went to SNFs, 18.2% received care from an HHA, 7.2% received hospice care, and 1.5% went to LTC facilities.

The data showed that 40.3% of patients with bone metastases and 45.5% of patients with MM were referred to institutional postacute care at an SNF or rehabilitation center.

“These percentages are higher than in the general Medicare population, reported to be 26.3% in 2015,” Li and colleagues noted.

All of that postdischarge care translated into significant posthospitalization health care costs. While patients receiving hospice care generally had postdischarge bills of less than $10,000; those who went to LTC nursing homes had stays totaling an average of $15,517. Those who were discharged to LTC hospitals had average bills of $46,479 and $49,729, for patients with bone metastases and MM, respectively.

Making matters worse, nearly 1 in 10 patients in both groups were rehospitalized within a month of discharge.

The findings suggest Medicare is paying hundreds of millions of dollars for postdischarge care at SNFs alone.

“Total Medicare allowable costs at SNFs after discharge from the index SRE hospitalization for both cohorts combined was about $91.52 million, about 40.3% of total post-discharge care,” the authors reported. “The extrapolated estimate of the same Medicare expenditures for the same patients in the entire Medicare population would be at least $457.6 million in the study period.”

The authors concluded by saying more must be done to prevent SREs in the first place.

“Post-discharge management after SRE hospitalization is clinically and economically significant for elderly patients, has significant implications for public health, and highlights the need for primary prevention of these painful and costly events,” they said.


Li S, Guo H, Peng Y, et al. Discharge status and post-discharge healthcare costs after skeletal-related event hospitalizations among Medicare patients with bone metastatic solid tumors or multiple myeloma. J Bone Oncol. 2020;26:100328. doi:10.1016/j.jbo.2020.100328