To perform an economic evaluation of APP care versus standard care models for managing upper extremity MSK disorders in four Danish orthopedic clinics in the societal perspective.To perform an economic evaluation of APP care versus standard care models for managing upper extremity MSK disorders in four Danish orthopedic clinics in the societal perspective.
This is a retrospective registry-based observational longitudinal study comparing healthcare costs and productivity loss per patient with upper extremity MSK disorders consulting in APP or standard models of care. Data related to sociodemographic, diagnoses, healthcare resource use, medication, costs, and sickness benefits within a two-year period after the initial consultation were extracted. Costs were adjusted for inflation and converted to Euros 2022. Propensity score weighting was used to adjust for confounders.
A total of 13,517 patients were included in the analysis. Participants in the standard and in the APP groups had similar baseline characteristics with a mean age of 50.9 ± 15.8 and 50.8 ± 15.5 years old, 49% and 51% female and mean Charlson score of 0.28 ± 0.74 and 0.29 ± 0.76, respectively. Participants were diagnoses with various upper extremity disorders, mainly involving the shoulder. Primary care medical costs were similar (MD: 0; 95% CI: -21 to 21), while rehabilitation cost was higher with APP model of care (MD: 18; 95% CI: 8 to 28). Medication costs were lower with APP care (MD: -50; 95% CI: -58 to -43). The difference in hospital costs was not statistically significant (MD: 86; 95% CI: -305 to 476).
Overall, total healthcare costs, including both primary care and hospital costs, were not significantly different between the two groups (MD: 53; 95% CI: -345 to 451).The difference in productivity loss was not statistically significant (MD: 197; 95% CI: -1678 to 2072). There were 2223 (29.4%) and 1776 (29.8%) patients had productivity loss among the standard and APP care models respectively. There were 2223 (29.4%) and 1776 (29.8%) patients had productivity loss among the standard and APP care models respectively.
The distribution of healthcare cost slightly differs with higher rehabilitation and lower medication cost in the APP group, which ultimately led to a not statistically significant difference in total healthcare cost over a 2-year period. There was no significant between-group difference in productivity loss over a 2-year period.
Our results suggest that healthcare costs for an APP model of care are similar to those of a standard orthopedic model in Denmark. This indicates that healthcare costs should not be a barrier to the broader implementation of APP models. Uncertainty remains regarding the impact on productivity loss, as variability was high, with a minority of patients driving this due to prolonged work absenteeism.
Healthcare organization
Health economic
