Predictors of high-cost patients with acute whiplash-associated disorder in Japan.

Hayashi, Kazuhiro; Miki, Kenji; Ikemoto, Tatsunori; Ushida, Takahiro; Shiro, Yukiko; Tetsunaga, Tomoko; Takasusuki, Toshifumi; Hosoi, Masako; Yukioka, Masao · 2023 · DOAJ

DOI: 10.1371/journal.pone.0287676

archive: archived pipeline: cataloged verified

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Summary

This study investigates the predictors of high healthcare costs among patients with acute whiplash-associated disorder (WAD) in Japan. While WAD is a common consequence of traffic accidents, little was previously known about which treatment-related variables drive excessive healthcare expenditures in this population. The research was motivated by the high economic burden of pain-related conditions and the unique Japanese healthcare context, where consultation rates are among the highest globally and alternative medicine is widely covered by insurance. The authors aimed to determine whether time to first medical visit, multiple doctor visits, or use of alternative medicine could predict high-cost outcomes. The researchers analyzed anonymous data from the General Insurance Rating Organization of Japan, a compulsory no-fault automobile liability insurance agency, covering the period from 2014 to 2019. The study included 104,911 participants with acute WAD Grade 1 or 2 following traffic accidents. Patients were categorized into low, medium, and high-cost groups based on the percentiles of their total healthcare costs, which included conventional medicine, alternative medicine (defined as judo or massage therapy), pain and suffering payments, and miscellaneous expenses. The study employed univariate and multivariate logistic regression analyses to identify independent predictive factors for high costs, comparing patient demographics, traffic accident characteristics, and treatment behaviors. The results identified multiple doctor visits and visits for alternative medicine as the strongest independent predictors of high healthcare costs. In multivariate analysis, these factors exhibited extremely high odds ratios: 2,673 for multiple doctor visits and 694 for visits to alternative medicine. Patients engaging in these behaviors incurred a median total healthcare cost of 292,346 yen, compared to 53,587 yen for those who did not. Other significant predictors for high costs included female sex, being a homemaker, a history of prior WAD claims, residential area, and patient responsibility in the accident. Conversely, being a student and involvement in a rear-end collision were associated with lower costs. The study also found that total healthcare costs were significantly correlated with clinical outcomes, including the number of visits and duration of treatment. The findings indicate that treatment patterns, specifically the utilization of multiple medical providers and alternative therapies, are strongly associated with increased healthcare expenditures and prolonged compensation closure times for acute WAD patients in Japan. This suggests that overtreatment or fragmented care in the initial phase after injury may contribute to higher costs and slower recovery. The study highlights the need for clinical guidelines that address these specific treatment behaviors to manage costs and improve outcomes for WAD patients within the Japanese insurance system.

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• demographic disparities