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Study: Rotator cuff repair delivers increased lifetime societal cost savings, improved quality of life
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For patients less than 61 years old, the total estimated lifetime societal savings of the approximately 250,000 rotator cuff repairs performed annually in the United States is $3.44 billion, according to a study of the value of rotator cuff repair published in the Journal of Bone & Joint Surgery.
“The societal burden of rotator cuff tears is potentially significant, considering their impact on people’s ability to work and remain productive,” Lane Koenig, PhD, health economist at KNG Health Consulting and a study author, stated in a press release. “Fortunately, what this research enables us to do is quantify this value. It truly offers a new perspective to the body of information available about this condition.”
Koenig and colleagues constructed a Markov decision model to compare and estimate the lifetime savings of surgical and nonsurgical treatment of symptomatic full-thickness rotator cuff tears, according to the abstract. They found surgical treatment carried an additional mean age-weighted total savings of $13,771 over the patient’s lifetime compared to nonsurgical treatment.
When they compared a repair to nonoperative treatment, the total societal savings calculated was $77,662 for patients between 30 years and 39 years old and the calculated net cost to society was $11,997 for patients between 70 years old and 79 years old. Koenig and colleagues found that surgery increased the quality-adjusted life-years of all patients by 0.62 years, mean.
They noted that the study does not suggest surgery should be performed for all patients with rotator cuff tears, but that surgery “minimizes the societal burden of rotator cuff disease.”
Reference:
Mather RC. J Bone Joint Surg Am. 2013;doi:10.2106/JBJS.L.01495.
Disclosure: The authors received support from the National Institutes of Health, the American Academy of Orthopaedic Surgeons, KNG Health Consulting and its partner IHS Global Inc. to conduct this study.
Perspective
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John G. Costouros, MD, FACS
Musculoskeletal disorders are the leading cause of disability in the United States and impose tremendous financial burden to our system both socially and economically. More than ever, the value that we bring as orthopedic surgeons is being scrutinized. The treatment of shoulder disorders, specifically rotator cuff disease, is a large component of health care expenditure and accounts for roughly 4.5 million patient visits per year and $5 billion dollars per year in medical costs and decreased productivity. The financial burden is only expected to grow with increased life expectancy, delayed retirement and increased activity demands in the elderly population.
The present study is the first to examine the societal and economic value of repair of full-thickness rotator cuff tears. The authors used a Markov decision model to estimate lifetime direct and indirect costs of surgical vs. conservative treatment of symptomatic tears.
Surgical treatment resulted in an age-adjusted net positive societal savings of $13,771 over a patient’s lifetime and an average improvement of 0.62 quality-adjusted life years. As expected, the financial impact was most dramatic for younger patients and most significant for patients younger than age 61 years. This study estimated a lifetime societal savings of $3.44 billion for rotator cuff repairs performed in one given year.
Rotator cuff repair is a cost-effective treatment for patients with full-thickness tears compared to conservative measures over the course of a lifetime. Hopefully, this investigation will lead to many future studies examining the financial and societal cost-effectiveness of various surgical treatments in orthopedic surgery.
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