{
  "abstract": "Background\n\nMassive irreparable rotator cuff tears are managed along a surgical spectrum from arthroscopic debridement to reverse shoulder arthroplasty (RSA). The biodegradable subacromial balloon spacer is a minimally invasive option with limited real-world payer-perspective comparative evidence.Objectives\n\nTo quantify postoperative complications, payer reimbursement, and care-pathway utilization for balloon spacer implantation vs four surgical alternatives in routine statutory health insurance (SHI) practice.Methods\n\nRetrospective propensity-score-matched cohort analysis of anonymized claims from a German SHI database (~4.5 million insured). Adults treated surgically for rotator cuff pathology (ICD-10-GM M75.1) between 2017 and 2020 were included. Balloon spacer patients (n = 99) were matched 1:2 on propensity scores against RSA, open repair, arthroscopic repair, and debridement. Primary outcomes were 12- and 24-month complication rates and index hospitalization costs; secondary outcomes were shoulder-related sick leave and time to first physiotherapy.Results\n\nBalloon spacer hospitalization costs (€3502) were 65% lower than RSA (€9969) and modestly lower than open repair (€3829); arthroscopic repair (€3245) and debridement (€2464) were less expensive. Twelve-month complications were lower than RSA (1.3% vs 12.2%) and comparable to other comparators. Physiotherapy began earlier after balloon spacer (11.4 days) than RSA (27.6), open repair (20.0), or arthroscopic repair (18.1). In a small exploratory subgroup aged 60 to 64 years (n = 15 to 19 balloon spacer patients per comparison), sick leave duration and indirect costs were directionally lower for the balloon spacer, but these estimates are hypothesis-generating only. The balloon spacer occupied a cost-efficient position in the surgical care pathway, and the cost gap vs RSA was robust in an inpatient-only sensitivity analysis. Residual confounding by indication cannot be excluded.Conclusions\n\nWithin a large German SHI dataset, balloon spacer implantation was associated with substantially lower direct hospitalization costs than RSA, comparable safety to less invasive alternatives, and earlier physiotherapy initiation. A subgroup signal of reduced indirect costs in working-age patients rested on very small samples and should be regarded as hypothesis-generating rather than as input for payer policy modeling. These findings support the device as a de-escalation option for appropriately selected patients in payer systems facing rising arthroplasty utilization.",
  "abstract_shown": true,
  "affiliations": [
    "Stryker, Endoscopy Europe, Freiburg, Germany.",
    "Stryker GmbH & Co. KG, Duisburg, Germany.",
    "Inspiring-Health GmbH, Munich, Germany.",
    "WIG2 GmbH - Scientific Institute for Health Economics and Health System Research, Leipzig, Germany.",
    "Ostsee Klinik, Bad Schwartau, Germany.",
    "Gelenkchirurgie Orthopädie, Hannover, Germany."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Marc Harms",
      "orcid": "0000-0003-2546-2845"
    },
    {
      "affs": [
        1
      ],
      "name": "Christoph Pross"
    },
    {
      "affs": [
        2
      ],
      "name": "Harald Kuhlmann"
    },
    {
      "affs": [
        3
      ],
      "name": "Tarcyane Barata Garcia",
      "orcid": "0000-0002-2038-1395"
    },
    {
      "affs": [
        4
      ],
      "name": "Jan Eßer"
    },
    {
      "affs": [
        5
      ],
      "name": "Jens Agneskirchner"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4gq3v23e6ebyg.bib",
  "cited_by": 0,
  "doi": "10.36469/001c.164920",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13727280/?tool=EBI",
  "id": "4gq3v23e6ebyg",
  "issns": [
    "2326-697X",
    "2327-2236"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13727280",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Musculoskeletal Conditions"
    ],
    [
      "openalex",
      "2746|Shoulder Injury and Treatment"
    ]
  ],
  "openalex": "W7214097699",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13727280/pdf/?tool=EBI",
  "pmcid": "PMC13727280",
  "pmid": "42974383",
  "published": "2026-09-23",
  "publisher": "Columbia Data Analytics, LLC",
  "ris": "https://research.draconitic.com/paper/4gq3v23e6ebyg.ris",
  "sources": [
    {
      "first_seen": "2026-11-03T15:20:51Z",
      "native_id": "PMC:PMC13727280",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13727280"
    },
    {
      "first_seen": "2026-11-04T15:20:49Z",
      "native_id": "MED:42974383",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42974383"
    },
    {
      "first_seen": "2026-11-05T12:23:23Z",
      "native_id": "PMC13727280",
      "source": "pmc",
      "url": "https://doi.org/10.36469/001c.164920"
    }
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Shoulder Injury and Treatment",
      "subfield": "surgery"
    }
  ],
  "title": "Health Economic Outcomes of Subacromial Balloon Spacer Implantation Across Surgical Care Pathways: A Propensity-Matched Analysis of German Statutory Insurance Claims",
  "title_text": "Health Economic Outcomes of Subacromial Balloon Spacer Implantation Across Surgical Care Pathways: A Propensity-Matched Analysis of German Statutory Insurance Claims",
  "type": "peer-reviewed",
  "updated_at": "2026-11-06T12:22:59Z",
  "url": "https://research.draconitic.com/paper/4gq3v23e6ebyg",
  "venue": "Journal of health economics and outcomes research",
  "versions": []
}