Abstract
Background
Operative treatment of complex proximal humerus fractures remains controversial. The transition to value-based health care demands a better understanding of the costs associated with surgery. The purpose of this study was to examine the 90-day costs of three common surgical treatments for proximal humerus fractures and non-operative treatment and compare the costs associated with the initial-day and subsequent 89-days of care.
Methods
A query of the Humana insurance claims database was performed through the PearlDiver Supercomputer (Warsaw, IN) from 2010 to 2014 using the diagnosis codes for proximal humerus fractures together with current procedural terminology codes (CPT) for hemiarthroplasties (HA), open reduction internal fixation (ORIF), reverse shoulder arthroplasty (RSA) and nonoperative treatment (NO). Reimbursement from the insurance claims database was used as a marker for costs. The same day, subsequent 89-day, and ninety day costs were analyzed trough the use of descriptive and comparative statistical analysis.
Results
RSA was the most costly procedure for the same-day and 90-day costs (p<0.001) (Figure 1). Mean initial-day reimbursement costs were significantly different amongst treatment groups, with the highest costs seen with RSA ($16,151), followed by HA ($9,348), ORIF ($6,745) and lastly, NO ($1,932). Subsequent 89-day reimbursement costs were not significantly different for RSA, HA and ORIF (p=0.112) (Figure 1 and 2); however, NO treatment incurred significantly lower costs (p=0.008) (Figure 3).
Conclusion
The 90-day costs for the surgical treatment of proximal humerus fractures are driven by the initial-day costs. RSA was associated with the highest cost, followed by HA and ORIF. NO management incurred the lowest costs.
