Smith & Nephew Inc., Andover, MA, USA.
Arlington County Department of Human Services, Arlington, VA, USA.
Curr Med Res Opin. 2021 Jul;37(7):1199-1211. doi: 10.1080/03007995.2021.1918074. Epub 2021 May 19.
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.
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.
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 <0.001) for partial- and full-thickness tear patients, respectively.
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.
本回顾性研究调查了肩袖撕裂（RCT）和肩袖修复（RCR）相关的治疗特征和经济负担。此外，本研究旨在探讨延迟手术干预相关的经济影响。
使用 IBM Watson Health MarketScan 商业数据库，于 2013 年 1 月 1 日至 2017 年 6 月 30 日，筛选符合入选标准的成人 RCT 患者。还分析了索引后 12 个月内发生 RCR 且在 RCR 日期后连续 12 个月有入组记录的患者。早期手术定义为 RCT 后 6 个月内和部分厚度撕裂及全厚度撕裂诊断后 1 个月内进行的 RCR。根据 RCT 类型报告患者特征、全因直接成本（计划支付和患者自付费用）、RCT 相关成本、术前成本、术后成本和医疗资源利用情况。还估计了归因于间接成本、缺勤和短期残疾（STD）的费用。
共确定了 102488 例 RCT 患者（部分厚度撕裂：46856 [45.7%]；全厚度撕裂：55632 [54.3%]）。50%的 RCT 患者在诊断后 12 个月内接受了 RCR。全厚度 RCT 患者的基线（诊断前一年）和指数后平均总费用分别为 17096 美元和 32110 美元。同样，部分厚度患者的基线费用为 16385 美元，指数后费用为 27017 美元。部分厚度撕裂患者的全因年度术后平均费用为 34086 美元，全厚度撕裂患者为 34249 美元，其中分别有 40%和 38%的费用与 RCT 相关。在术后 12 个月期间，因缺勤和 STD 导致的生产力损失分别为部分厚度撕裂患者的 5843 美元和 4493 美元，全厚度撕裂患者的 5770 美元和 4382 美元。诊断与手术之间，每例延迟手术患者的平均额外支出分别为部分厚度撕裂患者 8524 美元和全厚度撕裂患者 3213 美元（均<0.001）。
本探索性分析表明，肩袖撕裂和肩袖修复给医疗保健系统带来了相当大的经济负担。高医疗利用率和成本突显了高效管理 RCT 诊断患者的重要性。数据还表明，如果预计在 RCT 后进行手术干预，早期手术干预可能具有经济意义。
