Alleviating Shoulder Pain in Adults:
Rotator Cuff Surgery is a Cost-Effective Treatment Option

For rotator cuff injuries, understanding treatment options and costs and benefits can help patients choose the right course to save money and continue to be active in their work and personal lives.

Just like 4.5 million Americans each year, Wesley Linton and Michaela “Pinky” Puno visited their doctors with extreme shoulder pain. However, today they are able to keep doing what they love, work and support their families. Linton, a firefighter in Winston Salem, North Carolina, can rescue victims from fires, complete 50 push-ups with no pain and lift patients needing assistance. Puno, an amateur ballroom dancer, can continue improving her technique, practice two hours a day and dance competitively. Both patients are able to live full lives thanks to the rotator cuff surgery they had to ease their shoulder pain.

In their cases, Linton and Puno required surgery to repair their rotator cuffs. However, many patients do not require surgery to alleviate their shoulder pain.  The American Academy of Orthopaedic Surgeons recently released Appropriate Use Criteria (AUC) to help guide orthopaedic surgeons as they determine when a patient requires surgery. The AUC covers five different common treatments for rotator cuff injuries and helps clinicians identify when each type of treatment is appropriate.

Rotator cuff surgery options and criteria

For patients who do require or choose surgery, as Linton and Puno did, a new research study suggests that surgical treatment for rotator cuff tears reduces indirect costs, including the ability to work and fewer missed work days. The authors of “The Societal and Economic Value of Rotator Cuff Repair,” estimate these surgeries result in a lifetime societal savings in the U.S. of approximately $3.44 billion annually.

As prevalence of rotator cuff tears increase with age and the workforce becomes older, examining the cost-savings of rotator cuff surgeries is an important issue. The study, published in the Journal of Bone and Joint Surgery (JBJS), is the first-of-its-kind to offer a comprehensive look at the societal impact of rotator cuff disease and its treatments. Comparing surgical and non-surgical treatment options, the study’s investigators found rotator cuff repair is cost effective across all patient age groups.

Additionally, societal savings offset the direct costs of treatment in patients younger than age 61, resulting in an average net savings of $13,771 per patient. This number significantly increased to $77,662 for patients younger than 40.

In addition to the video at the top of the page, more information is available here:

Frequently Asked Questions

  • What is the rotator cuff? The rotator cuff is a group of muscles and tendons that work together to stabilize the shoulder and allow it to move in various directions.
  • What are common causes of rotator cuff injuries? Approximately 4.5 million patient visits occur each year in the United States related to shoulder pain, and rotator cuff injuries are one of the most common causes.  The rotator cuff can become worn down and deteriorate due to aging or trauma (such as falling and injuring the shoulder or overuse in sports).
  • How are rotator cuff injuries treated? The most severe rotator cuff injuries often require surgery to repair the damage. These procedures can be done by either arthroscopy or open surgery, and involve mending the torn rotator cuff by suturing the tissues back together. Recovery from surgery often requires extended physical therapy and rehabilitation. In less severe injuries, physical therapy and/or rehabilitation, at-home exercises and medication for pain are examples of common treatment regimens.
  • What is the purpose of the research on societal savings and why is it important? The impact of rotator cuff tears on earnings, missed work days, and disability payments was largely unknown, which is why the American Academy of Orthopaedic Surgeons (AAOS) developed this study. It examines the value of surgical treatment for full thickness rotator cuff tears from a societal perspective, which includes the costs and benefits to patients, employers, payers, and the government. Rotator cuff injuries can affect anyone, but risk increases with age. The societal burden of rotator cuff tears is potentially significant, considering their impact on people’s ability to work and remain productive.
  • What data was used to assess the economic value of rotator cuff surgery and how was it analyzed? Model assumptions were obtained from literature review and an analysis of Medicare claims data, as well as data from the State Ambulatory Surgery Databases (SASD) for a sample of states. Estimates of indirect costs were obtained from an analysis of the National Health Interview Survey (NHIS) and patient outcomes data from a multi-practice orthopaedic surgery group.  Results from the analysis were incorporated into a Markov Decision Model, a standard predictive tool that accounts for various possible outcomes.  Four indirect cost components were modeled: probability of employment, household income, missed work days, and disability payments.  Direct cost estimates were based on average Medicare reimbursements with adjustments to an all-payer population and effectiveness was expressed in quality adjusted life years (QALYs).
  • What did the research conclude? In comparing surgical repair and non-operative treatment, the study found that surgical treatment for rotator cuff tears reduces indirect costs and more than offsets the direct costs of treatment in patients under age 61, resulting in a net savings to society. The study determined there was an estimated lifetime societal savings of approximately $3.44 billion from the approximately 250,000 rotator cuff repairs performed in the U.S. The age-weighted mean total societal savings per person from rotator cuff repair, as compared with non-surgical treatment, was $13,771 (2012 dollars).
  • How will the research be used in the future and what is its impact on health care costs? This is the first study to examine the total societal impact of rotator cuff tears and its potential treatments. This research model provides a foundation for assessing the value of procedures and health services, and in the future can be applied to other medical specialties beyond those mentioned above to ultimately reduce excess health care spending.