Patient Characteristics and Provider Specialties Associated with Treatment Expenses for Thumb Carpometacarpal Arthritis.

Abstract

Background: Thumb carpometacarpal (CMC) arthritis can be treated with a variety of nonsurgical and surgical means. The authors hypothesized that specific groups of providers and patients are associated with increased financial burden from both patient and health care perspectives.

Methods: The Optum Clinformatics DataMart Database (2014 to 2018) was used to perform a retrospective population-based study. Patients newly diagnosed with thumb CMC arthritis were identified and divided into 2 cohorts: surgical and nonsurgical treatment only cohort (ie, splint, steroid injection, and hand therapy). The authors identified all treatments received, sociodemographic characteristics, and specialty of the provider. Tobit regression was used to identify correlations with increased total payments by insurer, out-of-pocket expenses, facility fees, and provider fees.

Results: A total of 18,766 patients were included; 529 patients (3%) received surgical treatment, and 18,237 patients (97%) received nonsurgical treatment only. Nonsurgical treatment regimens varied widely among provider specialties and were associated with significant discrepancies in direct costs to the patient and the health care system. Nearly 40% of patients who received surgery had attempted only 1 type of nonsurgical treatment prior. Across both treatment cohorts, the largest discrepancies in treatment expenses were related to facility fees, which increased significantly in nonsurgical treatment regimens that used steroid injection.

Conclusions: Providers should apply current evidence that supports multimodal nonsurgical treatments before surgical referral for thumb CMC arthritis. From an economic standpoint, it may be worthwhile to consider whether nonsurgical treatment should commence with less expensive alternatives to steroid injection, such as hand therapy exercises and splint.