Health Economic Outcomes of Subacromial Balloon Spacer Implantation Across Surgical Care Pathways: A Propensity-Matched Analysis of German Statutory Insurance Claims
6 affiliations
- 1Stryker, Endoscopy Europe, Freiburg, Germany.
- 2Stryker GmbH & Co. KG, Duisburg, Germany.
- 3Inspiring-Health GmbH, Munich, Germany.
- 4WIG2 GmbH - Scientific Institute for Health Economics and Health System Research, Leipzig, Germany.
- 5Ostsee Klinik, Bad Schwartau, Germany.
- 6Gelenkchirurgie Orthopädie, Hannover, Germany.
Abstract
Background
Massive 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
To 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
Retrospective 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
Balloon 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
Within 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.
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BibTeX
@article{harms2026health,
title = {{Health Economic Outcomes of Subacromial Balloon Spacer Implantation Across Surgical Care Pathways: A Propensity-Matched Analysis of German Statutory Insurance Claims}},
author = {Marc Harms and Christoph Pross and Harald Kuhlmann and Tarcyane Barata Garcia and Jan Eßer and Jens Agneskirchner},
journal = {Journal of health economics and outcomes research},
year = {2026},
month = sep,
doi = {10.36469/001c.164920},
url = {https://europepmc.org/article/PMC/PMC13727280},
note = {CC BY},
}
RIS
TY - JOUR
TI - Health Economic Outcomes of Subacromial Balloon Spacer Implantation Across Surgical Care Pathways: A Propensity-Matched Analysis of German Statutory Insurance Claims
AU - Marc Harms
AU - Christoph Pross
AU - Harald Kuhlmann
AU - Tarcyane Barata Garcia
AU - Jan Eßer
AU - Jens Agneskirchner
PY - 2026
DA - 2026/09/23
JO - Journal of health economics and outcomes research
DO - 10.36469/001c.164920
UR - https://europepmc.org/article/PMC/PMC13727280
AB - Background Massive 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 To 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 Retrospective 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 Balloon 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 Within 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.
SN - 2326-697X
SN - 2327-2236
ER -