Objectives:

To understand current treatment patterns for rotator cuff tear (RCT), including conservative treatment or rotator cuff repair (RCR), and the associated economic burden in Japan.

Methods:

This study used JMDC insurance claims data from January 2012–February 2021. Patients aged ≥18 years were eligible if they had ≥1 inpatient claim or ≥2 non-diagnostic outpatient claims (≥1 month apart) for RCT, 12 months pre- and post-index continuous enrollment. Index month was the month of first RCT claim. Healthcare costs and resource use were examined in the 12-month pre-index (baseline) and 12-month post-index periods. The RCR cohort was defined as patients with an RCR during the 12-month post-index period.

Results:

Initial tendinosis patients (a broader, less severe diagnosis) had RCT diagnosed after a mean 5.5 months (SD 4.0). 14,967 RCT patients were indexed (62.5% male; mean [SD] age: 52.2 [10.9]); only 843 (5.6%) received specific diagnoses of partial/complete RCT. Within 12 months post-index, 1,321 (8.8%) received RCR surgery. Baseline medication use was similar for RCR/non-RCR: 78.4%/72.7% for non-opioids; 22.3%/20.7% for opioids; 38.5%/28.0% for cortisone medications. Mean (SD) baseline total healthcare costs for non-RCR vs RCR was ¥279,250 (¥707,862) vs ¥244,223 (¥438,462). Post-index, all-cause opioid use was higher for RCR patients but remained substantial for non-RCR (96.1% vs 25.7%); RCR/non-RCR cortisone (60.4%/52.8%) and non-opioid pain medication (99.6%/90.5%) use were similar. Almost all RCR patients (99.2%) received physical therapy (non-RCR: 63.3%). Post-index mean (SD) all-cause outpatient costs for RCR/non-RCR patients were ¥416,059 (¥319,309)/¥273,905 (¥423,720). 99.8%/10.3% of RCR/non-RCR patients had inpatient stays (mean [SD] costs: ¥1,300,965 [¥735,918]/¥916,284 [¥1,277,012]).

Conclusions:

In Japan, many patients receive delayed RCT diagnoses, which are often also non-specific to partial/complete tears. Furthermore, while RCR-related costs are high within a year of diagnosis, non-RCR patients present a substantial and continuing healthcare burden due to prolonged and recurring treatment and associated costs.