High healthcare utilization and associated costs in the year prior to both primary reverse and anatomic shoulder arthroplasty: a study of 2393 patients from a private insurance database

Abstract

Background

Reverse shoulder arthroplasty (rTSA) has recently become more prevalent than anatomic shoulder arthroplasty (aTSA) in primary settings. With a shift toward value-based healthcare models, it is essential to quantify the costs of nonoperative management to optimize resource utilization. The purpose of this investigation was to quantify the cost of non-operative interventions in the year prior to both aTSA and rTSA.

Methods

An observational cohort study was conducted using the IBM Watson Health MarketScan databases. Patients with shoulder arthritis who underwent unilateral, isolated primary aTSA or rTSA from January 1, 2018, to December 31, 2019, were included. The main outcome was the total costs of nonoperative procedures in the year before surgery. The nonoperative procedures examined were (1) physical therapy (PT); (2) bracing; (3) intra-articular injections: professional fee, hyaluronic acid, and corticosteroids; (4) medication: nonsteroidal anti-inflammatory drugs, opioids, and acetaminophen; and (5) shoulder-specific imaging.

Results

The study comprised 2393 patients undergoing aTSA and rTSA. The average cost of nonoperative management in the year preceding shoulder arthroplasty was $1416 ± 2271 for a total of nearly $2.6 million (USD). The total cost of nonoperative procedures was significantly higher for women compared to men ($1552 ± 2268 vs. $1323 ± 2270, P < .001). Patients undergoing rTSA incurred higher costs than those receiving aTSA ($1624 ± 2492 vs. $1092 ± 1827; P < .001), primarily due to increased spending on PT ($547 ± 1584 vs. $198 ± 1292; P < .001) and magnetic resonance imaging ($454 ± 790 vs. $242 ± 503; P < .001). For those awaiting surgery for 10 months or longer, significantly more was spent on nonoperative management ($2130.36 ± 45.6 vs. $1229.55 ± 409.18, P = .03), with PT contributing to this even in the later months.

Conclusion

There is high health care utilization and associated cost of nonoperative procedures in the year prior to rTSA and aTSA. rTSA patients had significantly higher preoperative utilization and costs, mainly due to PT and magnetic resonance imaging. Most notably, for those waiting more than 10 months for rTSA, nearly 30% of the spending occurred in the last 3 months preceding surgery. As shoulder arthroplasty volumes rise, especially with increasing rTSA, it is important to delineate the current usage. This will allow payors and surgeons to critically appraise nonoperative modalities and direct their use to optimize efficacy while providing value-based care.