The substantial economic burden of rotator cuff pathology: A nationwide cost‐of‐illness study

PURPOSE: The purpose of this study is to evaluate the nationwide economic burden of rotator cuff (RC) pathology by quantifying expenditures related to outpatient consultations including out-of-pocket expenses, hospitalisations and occupational insurance claims, within a national healthcare system. METHODS: To estimate outpatient costs and to analyse hospital admissions with a primary or secondary diagnosis related to RC pathology, data from 2017 to 2023 were retrieved from the Italian Ministry of Health outpatient specialist care database and SDO database, respectively. Data from INAIL's statistical archives was extracted focusing exclusively on recognised cases of occupational disease between 2019 and 2023. Descriptive statistics were used to summarise annual service volumes, costs and data trends. RESULTS: Outpatient service costs for a standard conservative treatment in the year 2023 amounted to approximately €1.7 billion. Theoretical remuneration for hospital discharges with primary diagnoses related to shoulder and RC pathologies revealed an annual expenditure for the year 2023 of €111 million and a total expenditure of €739 million from 2017 to 2023. These costs, based on diagnosis-related group (DRG) reimbursements, explicitly include all surgical expenses. Based on INAIL data, the average cost per occupational shoulder disease case for 2024 was estimated at approximately €25,700 per worker, and over 5 years, several €100 million were spent. CONCLUSION: The annual economic burden of RC pathology in Italy exceeds €2 billion yearly, coming from private and public spending related to conservative outpatient treatment services, hospital admissions and expenditure for work-related injuries. This figure provides a lower-bound estimate of the total economic burden, and future cost-analysis would benefit from consideration of indirect and physiotherapy-related costs. LEVEL OF EVIDENCE: Level III.