Purpose
To help strategize efforts to optimize value (relative improvement in health for resources invested),
we analyzed the factors associated with the cost of care and use of resources for
painful, nontraumatic conditions of the upper extremity.
Methods
The following were the most common upper extremity diagnoses in the Truven Health
MarketScan database: shoulder pain and rotator cuff tendinopathy, shoulder stiffness,
shoulder arthritis, lateral epicondylitis, hand arthritis, trigger finger, wrist pain,
and hand pain. Multivariable generalized linear regression models were constructed
accounting for sex, age, employment status, enrollment year, payer type, emergency
room visit, joint injection, magnetic resonance imaging (MRI), physical or occupational
therapy, outpatient and inpatient surgery, and insurance type. In addition, we assessed
the use of the following 4 diagnostic and treatment interventions: joint injection,
surgery, MRI, and physical or occupational therapy.
Results
Inpatient and outpatient surgery are the largest contributors to the total amount
paid for most diagnoses. Older patients had more injections for the majority of conditions.
Conclusions
Efforts to improve the value of care for nontraumatic upper extremity pain can focus
on the relative benefits of surgery compared with other treatments and interventions
to lower the costs of surgery (eg, office surgery and limited draping for minor hand
surgery).
Type of study/level of evidence
Economic II.
Key words
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Article info
Publication history
Published online: February 16, 2019
Accepted:
January 2,
2019
Received:
April 13,
2018
Footnotes
D.R. received royalties from Wright Medical for elbow plates in the amount of less than U.S. $10,000 per year and Skeletal Dynamics for an internal joint stabilizer elbow in the amount of more than U.S. $10,000 per year; is a Deputy Editor for Hand and Wrist, Journal of Orthopaedic Trauma, and Clinical Orthopaedics and Related Research in the amount of U.S. $5,000 per year; and received honoraria from meetings of AO North America, AO International, and various hospitals and universities. The rest of the authors declare that they have no relevant conflicts of interest.
Identification
Copyright
© 2019 by the American Society for Surgery of the Hand. All rights reserved.
