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Double-Row Arthroscopic Rotator Cuff Repair Is More Cost-Effective Than Single-Row Repair
Adrian L Huang1, Kednapa Thavorn, Sasha van Katwyk
11Division of Orthopedics (A.L.H. and P.L.) and Clinical Epidemiology Program (K.T. and S.v.K.), Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada 2School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada 3Institute of Clinical and Evaluative Sciences, Ottawa, Ontario, Canada 4Section of Orthopaedic Surgery and the Pan Am Clinic, University of Manitoba, Winnipeg, Manitoba, Canada.
Background:
The optimal technique for arthroscopic rotator cuff repair is controversial, and both single and double-row techniques are commonly used. In the current era of increasing costs, health-care delivery models are focusing on the value of care. In this study, we compared the cost-effectiveness of single-row and double-row reconstructions in patients undergoing arthroscopic rotator cuff repair.
Methods:
A cost-utility analysis was performed from the perspective of a publicly funded health-care system. Health-care costs, probabilities, and utility values were derived from the published literature. Efficacy data were obtained from a previous randomized controlled trial comparing the effect of single-row (n = 48) or double-row (n = 42) reconstruction among 90 surgical patients. Unit cost data were obtained from a hospital database and the Ontario Schedule of Benefits and Fees. Results are presented as an incremental cost per quality-adjusted life year (QALY) gained. All costs are presented in 2015 Canadian dollars. A series of 1-way and probabilistic sensitivity analyses were performed.
Results:
Double-row fixation was more costly ($2,134.41 compared with $1,654.76) but was more effective than the single-row method (4.073 compared with 4.055 QALYs). An incremental cost-effectiveness ratio (ICER) was estimated to be $26,666.75 per QALY gained for double-row relative to single-row fixation. A subgroup analysis demonstrated that patients with larger rotator cuff tears (≥3 cm) had a lower ICER, suggesting that double-row fixation may be more cost-effective for larger tears.
Conclusions:
Based on the willingness-to-pay threshold of $50,000 per QALY gained, double-row fixation was found to be more cost-effective than single-row. Furthermore, a double-row reconstruction was found to be more economically attractive for larger rotator cuff tears (≥3 cm).
Level Of Evidence:
Economic and Decision Analysis Level IV. See Instructions for Authors for a complete description of levels of evidence.