{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T17:58:39Z","timestamp":1785347919208,"version":"3.55.0"},"reference-count":30,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>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\u2010of\u2010pocket expenses, hospitalisations and occupational insurance claims, within a national healthcare system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Outpatient service costs for a standard conservative treatment in the year 2023 amounted to approximately \u20ac1.7 billion. Theoretical remuneration for hospital discharges with primary diagnoses related to shoulder and RC pathologies revealed an annual expenditure for the year 2023 of \u20ac111 million and a total expenditure of \u20ac739 million from 2017 to 2023. These costs, based on diagnosis\u2010related 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 \u20ac25,700 per worker, and over 5 years, several \u20ac100 million were spent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The annual economic burden of RC pathology in Italy exceeds \u20ac2 billion yearly, coming from private and public spending related to conservative outpatient treatment services, hospital admissions and expenditure for work\u2010related injuries. This figure provides a lower\u2010bound estimate of the total economic burden, and future cost\u2010analysis would benefit from consideration of indirect and physiotherapy\u2010related costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.70411","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T10:22:33Z","timestamp":1779445353000},"page":"2951-2967","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The substantial economic burden of rotator cuff pathology: A nationwide cost\u2010of\u2010illness study"],"prefix":"10.1002","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4063-9821","authenticated-orcid":false,"given":"Umile Giuseppe","family":"Longo","sequence":"first","affiliation":[{"name":"Fondazione Policlinico Universitario Campus Bio\u2010Medico Rome Italy"},{"name":"Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery Universit\u00e0 Campus Bio\u2010Medico di Roma Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9952-0986","authenticated-orcid":false,"given":"Martina","family":"Marino","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario Campus Bio\u2010Medico Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Candela","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario Campus Bio\u2010Medico Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"D'Amario","sequence":"additional","affiliation":[{"name":"Italian Workers' Compensation Authority (INAIL) Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Martini","sequence":"additional","affiliation":[{"name":"Italian Workers' Compensation Authority (INAIL) Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Bucciarelli","sequence":"additional","affiliation":[{"name":"Italian Workers' Compensation Authority (INAIL) Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ranieri","family":"Poli","sequence":"additional","affiliation":[{"name":"Ministero della salute, Dipartimento della salute umana, della salute animale e dell'ecosistema (One Health) e dei rapporti internazionali Ufficio 4 Rapporti internazionali Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pieter","family":"D'Hooghe","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgeon and Assistant Chief of Surgery for Research, Department of Orthopaedic Surgery and Sportsmedicine Aspetar Hospital Doha Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"de Sire","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences University of Catanzaro \u201cMagna Graecia\u201d Catanzaro Italy"},{"name":"Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG University of Catanzaro \u201cMagna Graecia\u201d Catanzaro Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Mercurio","sequence":"additional","affiliation":[{"name":"Magna Graecia University &amp; R. Dulbecco University Hospital of Catanzaro Catanzaro Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arianna","family":"Carnevale","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario Campus Bio\u2010Medico Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2018.09.007"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2020.9440"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2013.01.006"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-016-0165-8"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2474-9-78"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2474-8-123"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/23259671211021589"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-021-04634-6"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/JSA.0000000000000372"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13113340"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/ksa.12326"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-016-2610-x"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/2325967120937016"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1071\/AH17242"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.L.01495"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jor.2013.01.008"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0227688"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.13121947"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.csm.2022.08.009"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-023-02686-9"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacr.2018.09.032"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.xrrt.2024.09.004"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2474-13-238"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.5271\/sjweh.2895"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1080\/17453674.2019.1593641"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2006.06.013"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2009.04.006"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/CORR.0000000000001949"},{"key":"e_1_2_12_30_1","first-page":"1087","article-title":"Risk factors for full\u2010thickness rotator cuff tears: a systematic review and meta\u2010analysis","volume":"6","author":"Zhao J","year":"2021","journal-title":"EFORT Open Rev"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.21.25606"}],"container-title":["Knee Surgery, Sports Traumatology, Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ksa.70411","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ksa.70411","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ksa.70411","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T17:01:43Z","timestamp":1785344503000},"score":1,"resource":{"primary":{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/10.1002\/ksa.70411"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,22]]},"references-count":30,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1002\/ksa.70411"],"URL":"https:\/\/doi.org\/10.1002\/ksa.70411","archive":["Portico"],"relation":{},"ISSN":["0942-2056","1433-7347"],"issn-type":[{"value":"0942-2056","type":"print"},{"value":"1433-7347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,22]]},"assertion":[{"value":"2025-12-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}