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
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. Th...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-07-01
|
| Series: | JSES International |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S266663832500088X |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849412975730884608 |
|---|---|
| author | Jason Corban, MD Krishna Mandalia, BS Darren Nin, PhD Ya-Wen Chen, MD, MPH Yutung Lan, MD, MPH Ruijia Niu, MPH David Chang, PhD, MPH, MBA Eric Smith, MD Kaley Beall, MPH Sarav Shah, MD |
| author_facet | Jason Corban, MD Krishna Mandalia, BS Darren Nin, PhD Ya-Wen Chen, MD, MPH Yutung Lan, MD, MPH Ruijia Niu, MPH David Chang, PhD, MPH, MBA Eric Smith, MD Kaley Beall, MPH Sarav Shah, MD |
| author_sort | Jason Corban, MD |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-87cb83eaed4347b0bda1cc7e253b1aeb |
| institution | Kabale University |
| issn | 2666-6383 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JSES International |
| spelling | doaj-art-87cb83eaed4347b0bda1cc7e253b1aeb2025-08-20T03:34:17ZengElsevierJSES International2666-63832025-07-01941257126510.1016/j.jseint.2025.03.006High 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 databaseJason Corban, MD0Krishna Mandalia, BS1Darren Nin, PhD2Ya-Wen Chen, MD, MPH3Yutung Lan, MD, MPH4Ruijia Niu, MPH5David Chang, PhD, MPH, MBA6Eric Smith, MD7Kaley Beall, MPH8Sarav Shah, MD9Division of Sports Medicine, New England Baptist Hospital, Boston, MA, USADivision of Sports Medicine, New England Baptist Hospital, Boston, MA, USACodman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA, USACodman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA, USACodman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA, USADivision of Sports Medicine, New England Baptist Hospital, Boston, MA, USACodman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA, USADivision of Sports Medicine, New England Baptist Hospital, Boston, MA, USADivision of Sports Medicine, New England Baptist Hospital, Boston, MA, USADivision of Sports Medicine, New England Baptist Hospital, Boston, MA, USA; Corresponding author: Sarav Shah, MD, Department of Orthopedic Surgery, New England Baptist Hospital, 830 Boylston Street, Suite 106, Chestnut Hill, MA 02467, USA.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.http://www.sciencedirect.com/science/article/pii/S266663832500088XCost analysisHealthcare utilizationShoulderNon-operative managementReverse shoulder arthroplastyAnatomic shoulder arthroplasty |
| spellingShingle | Jason Corban, MD Krishna Mandalia, BS Darren Nin, PhD Ya-Wen Chen, MD, MPH Yutung Lan, MD, MPH Ruijia Niu, MPH David Chang, PhD, MPH, MBA Eric Smith, MD Kaley Beall, MPH Sarav Shah, MD 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 JSES International Cost analysis Healthcare utilization Shoulder Non-operative management Reverse shoulder arthroplasty Anatomic shoulder arthroplasty |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Cost analysis Healthcare utilization Shoulder Non-operative management Reverse shoulder arthroplasty Anatomic shoulder arthroplasty |
| url | http://www.sciencedirect.com/science/article/pii/S266663832500088X |
| work_keys_str_mv | AT jasoncorbanmd highhealthcareutilizationandassociatedcostsintheyearpriortobothprimaryreverseandanatomicshoulderarthroplastyastudyof2393patientsfromaprivateinsurancedatabase AT krishnamandaliabs highhealthcareutilizationandassociatedcostsintheyearpriortobothprimaryreverseandanatomicshoulderarthroplastyastudyof2393patientsfromaprivateinsurancedatabase AT darrenninphd highhealthcareutilizationandassociatedcostsintheyearpriortobothprimaryreverseandanatomicshoulderarthroplastyastudyof2393patientsfromaprivateinsurancedatabase AT yawenchenmdmph highhealthcareutilizationandassociatedcostsintheyearpriortobothprimaryreverseandanatomicshoulderarthroplastyastudyof2393patientsfromaprivateinsurancedatabase AT yutunglanmdmph highhealthcareutilizationandassociatedcostsintheyearpriortobothprimaryreverseandanatomicshoulderarthroplastyastudyof2393patientsfromaprivateinsurancedatabase AT ruijianiumph highhealthcareutilizationandassociatedcostsintheyearpriortobothprimaryreverseandanatomicshoulderarthroplastyastudyof2393patientsfromaprivateinsurancedatabase AT davidchangphdmphmba highhealthcareutilizationandassociatedcostsintheyearpriortobothprimaryreverseandanatomicshoulderarthroplastyastudyof2393patientsfromaprivateinsurancedatabase AT ericsmithmd highhealthcareutilizationandassociatedcostsintheyearpriortobothprimaryreverseandanatomicshoulderarthroplastyastudyof2393patientsfromaprivateinsurancedatabase AT kaleybeallmph highhealthcareutilizationandassociatedcostsintheyearpriortobothprimaryreverseandanatomicshoulderarthroplastyastudyof2393patientsfromaprivateinsurancedatabase AT saravshahmd highhealthcareutilizationandassociatedcostsintheyearpriortobothprimaryreverseandanatomicshoulderarthroplastyastudyof2393patientsfromaprivateinsurancedatabase |