Retrospective Study Identifies Surgical Treatment Patterns, Health Care Resource Utilization, and Economic Burden Associated With Tenosynovial Giant Cell Tumors

Tenosynovial giant cell tumors (TGCT) are rare but painful and locally aggressive cancers of the synovium, bursae, and tendon sheaths that damage affected joints and cause joint dysfunction. To evaluate the patterns of surgery and the economic burden of U.S. patients with TGCT who had joint surgery, researchers identified patients newly diagnosed with this neoplasm from the OptumHealth Care Solutions, Inc., claims database from the beginning of 1999 to the end of March 2017 (JHEOR. 2022;9(1):68-74. doi:10.36469/jheor.2022.32485). This database includes information on more than 19 million employee beneficiaries of 84 self-insured U.S. companies. To be included in the study, patients had to be continuously enrolled in their health insurance plan for at least 1 year before and at least 3 years after their first diagnosis of TGCT.

After identifying patients with TGCT, the researchers then assessed patterns of surgery after the first diagnosis of TGCT and compared healthcare resource utilization (HRU), associated healthcare costs, and indirect costs from lost work time during the first 3 years after diagnosis with these measures at baseline. 

Using these methods, the researchers identified 835 eligible patients with TGCT; 462 of these patients, or 55%, had at least one joint surgery after diagnosis and were included in the study. During a median follow-up of 5.7 years, 78% of patients had their first joint surgery in the first year after diagnosis, and 41% had at least 1 repeated surgery. Use of magnetic resonance imaging (MRI) was greatest during the baseline period (in 46%) and decreased thereafter; MRI use was 28% in the first year after diagnosis, 17% in the second year thereafter, and 19% in the third year thereafter.

During the baseline period, patients commonly used opioids (45%); nonsteroidal anti-inflammatory drugs (NSAIDs) (40%); and physical or occupational therapy and rehabilitation services (30%). Although more patients used opioids during the first year after diagnosis (78%) than during the baseline period (45%) (P<0.0001), use of this drug returned to less than baseline levels in the second and third years after diagnosis (41% and 42%, respectively). Use of NSAIDs and physical or occupation therapy and rehabilitation services followed a similar pattern.

Healthcare resource utilization and associated healthcare costs spiked in the first year after diagnosis and returned to baseline levels or less in the second and third years after diagnosis. Indirect costs associated with lost work time followed a similar pattern.

“The high proportion of patients undergoing repeat surgeries and prevalent use of opioids, NSAIDs, and physical/occupational therapy/rehabilitation services suggests an unmet medical need after surgical treatment,” wrote John Abraham, MD, FACS, Rothman Institute and Fox Chase Cancer Center, Philadelphia PA, and colleagues. 

“Surgical resection alone might be inadequate to control TGCT. New treatment options [e.g., targeted agents] may complement surgery and alleviate the clinical and economic burden experienced by patients with TGCT who had received prior surgery…. Weighing the side effects of these therapies against the symptomatic benefit on a patient-by-patient basis in TGCT remains critical.”