Operative vs Nonoperative Management of Achilles Tendon Rupture: A Cost Analysis.
Achilles tendon ruptures
cost utility
cost-comparison
nonoperative
operative
opioid
physical therapy
Journal
Foot & ankle orthopaedics
ISSN: 2473-0114
Titre abrégé: Foot Ankle Orthop
Pays: United States
ID NLM: 101752333
Informations de publication
Date de publication:
Jan 2023
Jan 2023
Historique:
entrez:
13
3
2023
pubmed:
14
3
2023
medline:
14
3
2023
Statut:
epublish
Résumé
Achilles tendon rupture (ATR) is a common injury with a growing incidence rate. Treatment is either operative or nonoperative. However, evidence is lacking on the cost comparison between these modalities. The objective of this study is to investigate the cost differences between operative and nonoperative treatment of ATR using a large national database. Patients who received treatment for an ATR were abstracted from the large national commercial insurance claims database, Marketscan Commercial Claims and Encounters Database (n = 100 825) and divided into nonoperative (n = 75 731) and operative (n = 25 094) cohorts. Demographics, location, and health care charges were compared using multivariable regression analysis. Subanalysis of costs for medical services including clinic visits, imaging studies, opioid usage, and physical therapy were conducted. Patients who underwent secondary repair were excluded. Operative treatment was associated with increased net and total payments, coinsurance, copayment, deductible, coordination of benefits (COB) / savings, greater number of clinic visits, radiographs, magnetic resonance imaging (MRI) scans, and physical therapy (PT) sessions, and with higher net costs due to clinic visits, radiographs, MRIs, and PT ( Compared with nonoperatively managed ATR, surgical repair is associated with greater costs partially because of greater utilization of clinic visits, imaging, and physical therapy sessions. However, surgical costs may be reduced when procedures are performed in ambulatory surgery centers vs hospital facilities. Nonoperative treatment is associated with higher prescription costs secondary to longer duration of opioid use. Level III, retrospective cohort study.
Sections du résumé
Background
UNASSIGNED
Achilles tendon rupture (ATR) is a common injury with a growing incidence rate. Treatment is either operative or nonoperative. However, evidence is lacking on the cost comparison between these modalities. The objective of this study is to investigate the cost differences between operative and nonoperative treatment of ATR using a large national database.
Methods
UNASSIGNED
Patients who received treatment for an ATR were abstracted from the large national commercial insurance claims database, Marketscan Commercial Claims and Encounters Database (n = 100 825) and divided into nonoperative (n = 75 731) and operative (n = 25 094) cohorts. Demographics, location, and health care charges were compared using multivariable regression analysis. Subanalysis of costs for medical services including clinic visits, imaging studies, opioid usage, and physical therapy were conducted. Patients who underwent secondary repair were excluded.
Results
UNASSIGNED
Operative treatment was associated with increased net and total payments, coinsurance, copayment, deductible, coordination of benefits (COB) / savings, greater number of clinic visits, radiographs, magnetic resonance imaging (MRI) scans, and physical therapy (PT) sessions, and with higher net costs due to clinic visits, radiographs, MRIs, and PT (
Conclusion
UNASSIGNED
Compared with nonoperatively managed ATR, surgical repair is associated with greater costs partially because of greater utilization of clinic visits, imaging, and physical therapy sessions. However, surgical costs may be reduced when procedures are performed in ambulatory surgery centers vs hospital facilities. Nonoperative treatment is associated with higher prescription costs secondary to longer duration of opioid use.
Level of Evidence
UNASSIGNED
Level III, retrospective cohort study.
Identifiants
pubmed: 36911422
doi: 10.1177/24730114231156410
pii: 10.1177_24730114231156410
pmc: PMC9998413
doi:
Types de publication
Journal Article
Langues
eng
Pagination
24730114231156410Informations de copyright
© The Author(s) 2023.
Déclaration de conflit d'intérêts
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. ICMJE forms for all authors are available online.
Références
J Bone Joint Surg Am. 2012 Dec 5;94(23):2136-43
pubmed: 23224384
Am J Sports Med. 2015 Jun;43(6):1530-7
pubmed: 25125693
Clin Podiatr Med Surg. 2017 Apr;34(2):251-262
pubmed: 28257678
Scand J Med Sci Sports. 2015 Feb;25(1):e133-8
pubmed: 24862178
Am J Sports Med. 2022 Aug;50(10):2680-2687
pubmed: 35834951
J Surg Orthop Adv. 2018 Winter;27(4):321-324
pubmed: 30777835
Am J Sports Med. 2008 Sep;36(9):1688-94
pubmed: 18645042
J Foot Ankle Surg. 2017 Nov - Dec;56(6):1236-1243
pubmed: 29079238
J Am Acad Orthop Surg. 2017 Jan;25(1):23-31
pubmed: 27898509
J Bone Joint Surg Am. 2010 Dec 1;92(17):2767-75
pubmed: 21037028
Knee Surg Sports Traumatol Arthrosc. 2018 Oct;26(10):3074-3082
pubmed: 29696317
J Am Acad Orthop Surg. 2016 Dec;24(12):865-871
pubmed: 27792057
Medicine (Baltimore). 2015 Nov;94(45):e1951
pubmed: 26559266
J Foot Ankle Surg. 2018 Nov - Dec;57(6):1191-1199
pubmed: 30368430
Arthrosc Sports Med Rehabil. 2019 Nov 29;1(2):e101-e107
pubmed: 32266346
Orthop J Sports Med. 2020 Mar 31;8(3):2325967120909918
pubmed: 32284940
Foot Ankle Surg. 2015 Dec;21(4):250-3
pubmed: 26564726
J Am Acad Orthop Surg. 2017 Jun;25(6):449-457
pubmed: 28459710
Am J Sports Med. 2016 Sep;44(9):2406-14
pubmed: 27307495
Am J Sports Med. 2013 Nov;41(11):2550-7
pubmed: 24005873
Knee Surg Sports Traumatol Arthrosc. 2013 Jun;21(6):1361-8
pubmed: 23377798
Sports Health. 2023 Jan-Feb;15(1):124-130
pubmed: 35635017