OBJECTIVES

First-line conservative treatment (e.g: physiotherapy and/or pain medications) for partial thickness rotator cuff tears (pRCT) often fails to control symptoms or prevent disease progression. This study aims to understand healthcare resource utilization (HRU) and direct and indirect economic burden in pRCT non-repair patients.

METHODS

Adult (aged ≥18 years) conservatively managed (without mention of surgical repair) pRCT patients from 2013-2017 with at least 12-months of continuous enrollment prior to and following the index date were identified from the IBM Watson Health MarketScan® Commercial healthcare claims database using ICD-9/10-CM codes. Total and RCT-related healthcare costs (plan paid and patient out-of-pocket payment) and HRU information were reported descriptively within 12 months of pRCT diagnosis. Mean days missed from work, and absenteeism (ABS) or short-term disability (STD) attributable productivity costs (indirect costs) were also estimated.

RESULTS

29,774 patients were included, representing 64% of pRCT patients. On average, 75.7% of the patients had at least one physiotherapy visit (average visits: all-cause:26, RCT-related:11.4). 14.2% and 9.1% of the patients had at least one claim for physician administered opioid and non-opioid pain medications and 53.9% and 44.3% of the patients had at least one claim for opioid and non-opioid pain medicine prescription for management of RCT symptoms. 42% of the patients received at least one cortisone injection (average: 0.8 (±1.1.) injections). RCT-related cost accounted for around 13% of all-cause spending per patient [Total Healthcare costs: $22,693.67 (±$48,682.30); RCT-related costs: $2,841.16 (±6,180.12)]. Physiotherapy and outpatient pharmacy accounted for 21% and 9% of the RCT-related spending. Patients had more ABS days (33 days ±24) than STD days (13 days ±35) resulting in higher indirect costs (ABS:$5,559 ±$4,179, STD:$1,574 ±$4,138).

CONCLUSIONS

Conservative management of pRCT patients represents a significant direct and indirect healthcare burden. Given that these patients are managed and not repaired, studies with longer-term cost-implication are warranted.