A recent study published in The Journal of Bone and Joint Surgery found that the estimated lifetime societal 
savings of the approximately 250,000 rotator cuff repairs performed in the U.S. each year was $3.44 billion.
Here, Richard C. Mather, MD, assistant professor in the orthopedic surgery department at Duke University Medical Center in Durham, N.C., and a study author, discusses the importance of the findings as well as the hope that the study will change the way rotator cuff repair costs are viewed.
Question: How does this study impact the field of orthopedics, particularly at a time when every healthcare dollar is being scrutinized?
Dr. Richard Mather: It demonstrates that orthopedic care, specifically appropriate rotator cuff treatment, has positive economic benefits to society. This is critical because it represents a change in the thinking about musculoskeletal care, from a consumption good that increases quality of life and facilitates leisure activities to an investment good that increases productivity in the workplace.
One of the motivations for this study was the fear that when stakeholders are scrutinizing every healthcare dollar, they will take a myopic, cost-cutting approach that does not consider the full economic impact of a disease and its treatments. This approach can lead to small decreases in the direct costs of care but large increases in indirect costs, for example, lost productivity. This study aims to provide decision makers with complete information about the costs of rotator cuff treatment.
Q: Are the findings surprising or do they confirm what is already believed about rotator cuff repair cost?
RM: I think they are somewhat surprising as a whole, but not if one considers the functional improvement after rotator cuff repair. Since complications are rare and the surgery is typically outpatient, direct costs are predictable and limited compared to other interventions. Rotator cuff disease not only limits the ability to raise and lift the arm, it also causes substantial night pain. This night pain limits sleep and the cumulative effect is decreased productivity even for non-laborers.
One important finding that I believe confirms the experience of many orthopedists is that the total economic impact for patients who should have had rotator cuff repair but didn't is much greater than for those that could have gotten by without a surgery but got one. This suggests that impaired access to appropriate rotator cuff treatment could substantially increase costs for society and severely impact a number of patients.
Q: Will the findings of the study impact the number of rotator cuff repairs performed?
RM: I don't think it will have an observed impact but it may preserve current levels of access. In other words, I think without this study, we would see decreased numbers of rotator cuff repairs preformed due to incorrect assumptions about cost, but our hope is that this study will contribute to facilitating the correct number of repairs being performed.
Q: Is further research on this topic necessary?
RM: Absolutely. While rotator cuff repair is less costly for the average patient and society, many individual patients do well without surgery. Simulations of our model demonstrate that some patients do better with surgery and some do better without surgery.
However, those that needed surgery initially but didn't get it did the worst of any patient in terms of decreased quality of life and increased costs. The optimal cost-effective solution lies in finding out how to predict which individuals need surgery and which do not. This is the premise of personalized medicine and is why many experts see personalized medicine as the next major frontier.
More Articles on Orthopedic Studies:
Neuroaxial Anesthesia Lowers Risk of Complications, Deaths for Primary Joint Arthroplasty
Total Knee Replacement: 5 Key Outcome Comparisons of High & Low Volume Surgeons
Study: Cooled Radiofrequency Treatment Provides Relief From Back Pain