Direct and indirect economic burden associated with rotator cuff tears and repairs in the US

Abstract

Objective

This retrospective study examined treatment characteristics and the economic burden associated with rotator cuff tears (RCT) and rotator cuff repairs (RCR). Additionally, this study aimed to explore the economic implications associated with delayed surgical intervention.

Methods

Adult RCT patients meeting eligibility criteria were identified from 1/1/2013–6/30/2017 using the IBM Watson Health MarketScan Commercial database. Patients with incident RCR within 12 months post-index and 12 months continuous enrollment after the RCR date were also analyzed. Early surgery was defined as RCR within 6 months and 1 month from the partial-thickness tear and full-thickness tear diagnoses, respectively. Patient characteristics, all-cause direct costs (plan paid and patient out-of-pocket), RCT-related costs, pre-surgical costs, post-surgical costs, and healthcare resource utilization were reported by RCT type. Attributable indirect costs, absenteeism and short-term disability (STD), were also estimated.

Results

102,488 RCT patients were identified (partial-thickness tears: 46,856 [45.7%]; full-thickness tears: 55,632 [54.3%]). Fifty per cent RCT patients underwent RCR within 12-months of diagnosis. Full-thickness RCT patients had an average total baseline (one year pre-diagnosis) and post-index costs of $17,096 and $32,110, respectively. Similarly, partial thickness patients had baseline costs of $16,385 and post-index costs of $27,017. Mean all-cause annual post-surgery costs were $34,086 for patients with partial-thickness tears and $34,249 for patients with full-thickness tears, of which 40% and 38% of costs were RCT-related, respectively. Productivity losses due to absenteeism and STD in the 12-month post-surgery period averaged $5843 and $4493, respectively, for partial-thickness tear patients and $5770 and $4382, respectively, for full-thickness tear patients. Average additional spending per delayed surgical patient between diagnosis and surgery was $8524 and $3213 (both p <0.001) for partial- and full-thickness tear patients, respectively.

Conclusions

This exploratory analysis indicates considerable RCT and RCR economic burden to the healthcare system. High healthcare utilization and costs highlight the importance of efficiently managing patients with RCT diagnosis. Data also suggest that early surgical intervention may be economically beneficial if surgical intervention is anticipated post-RCT.

Keywords:

• Rotator cuff tear
• rotator cuff repair
• arthroscopy
• cost analysis
• treatment outcome

Transparency

Declaration of funding

This study was funded by Smith & Nephew, Inc.

Declaration of financial/other relationships

N.P., D.D. and P.T. are employed by Smith & Nephew, Inc. I.W. and L.C. are employed by IBM Watson Health as consultants and received funding from Smith & Nephew to conduct this study. D. J. M. is currently employed by Arlington County Department of Human Services and was employed by IBM Watson health during the completion of this study. This research was presented in part at the 2020 ISPOR conference in Orlando, FL. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

The authors thank Allison Perry and Jessamine Winer-Jones for writing assistance.

Additional information

Funding

This study was funded by Smith & Nephew, Inc.