Real-world clinical and economic impacts of delayed rotator cuff repair surgery in Japan: analysis of a large claims database

Abstract

Background

In patients with rotator cuff tears (RCTs), there is a lack of evidence regarding the impact of the timeliness of rotator cuff repair (RCR) surgery on treatment outcomes and overall healthcare burden. This study aimed to understand the impact of early vs. delayed RCR on real-world healthcare costs and resource use (HCRU) in Japan.

Methods

This study utilized JMDC health insurance claims data from January 2012 to February 2021. Patients aged ≥18 years were included if they had ≥1 inpatient or ≥2 nondiagnostic outpatient claims (≥1 month apart) for RCT (diagnosis codes S460/S468), had RCR (procedure codes K080-X) within 12 months postindex, and had 12 months post-RCR continuous enrollment. Index month was defined upon the first RCT claim, and surgery month was defined upon the first RCR. Patients were categorized as having had early (≤1 month postindex) or delayed (2–12 months postindex) RCR. RCT-related HCRU were reported for the 12-month postindex or postsurgery periods.

Results

Of 1243 RCR patients, 68.9% were male and the mean (standard deviation [SD]) age was 55.3 (8.9) years. Of 46.3% patients with an initial diagnosis of tendinosis, their RCT was diagnosed for only a mean (SD) of 5.7 (4.0) months later. The mean (SD) time from index to first RCR was 2.4 (2.3) months; 518 (41.7%) patients had early RCR. The mean total RCT-related healthcare costs were higher for patients with delayed vs. early RCR (P < .05 for both postindex and surgery). The mean (SD) postsurgery inpatient costs were higher for delayed vs. early RCR (¥1,260,066 vs. ¥1,119,381; P < .05), possibly partly driven by longer hospital stays among delayed RCR patients. Patients with delayed RCR had a higher mean number of physical therapy visits compared with early RCR, especially postsurgery (42.6 vs. 38.4; P < .05); physical therapy costs were significantly higher for delayed RCR patients, compared with early RCR, for both postindex or postsurgery periods (P < .05). During the postindex period, higher proportions of delayed vs. early RCR patients received opioids (22.1% vs. 16.2%; P < .05), nonopioid pain medications (77.7% vs. 69.5%; P < .05), cortisone injections (47.2% vs. 33.8%; P < .05), and oral cortisone (4.8% vs. 1.4%; P < .05). The mean outpatient pharmacy prescription costs were significantly higher for delayed vs. early RCR for both the postindex and postsurgery periods (both P < .05).

Conclusions

Long delays in the diagnosis or treatment of RCT in Japan may lead to higher burdens of healthcare. Patients with delayed RCR may require more prescription medications and/or PT before and after surgery. Improving the timeliness of RCT treatment could therefore reduce overall HCRU.