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SLAP Repair Versus Biceps Tenodesis in Patients Younger Than 40 Years: A Cost-Effectiveness Analysis
Alexis B Sandler1, Benjamin R Childs1, John P Scanaliato1
1Department of Orthopaedics, William Beaumont Army Medical Center/Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA.
Insights
Biceps tenodesis is a more cost-effective surgical option than superior labrum anterior and posterior (SLAP) repair for type II SLAP tears in patients under 40. This procedure offers comparable outcomes and a 14% cost saving.
Area of Science:
- Orthopedic surgery
- Health economics
- Decision analysis
Background:
- Management of type II SLAP tears in young patients (<40 years) is debated.
- Evidence suggests similar outcomes for SLAP repair and biceps tenodesis, with fewer reoperations for tenodesis.
- Cost-effectiveness analysis is valuable given similar patient-reported outcomes.
Purpose of the Study:
- To compare the cost-effectiveness of primary SLAP repair versus primary biceps tenodesis for type II SLAP tears in patients younger than 40 years.
- To hypothesize that biceps tenodesis is more cost-effective.
Main Methods:
- Economic and decision analysis (Level of evidence, 4).
- A 10-year Markov model with 1-month cycles was used.
- Health states included return-to-sport and reoperation rates, informed by a systematic review and meta-analysis.
Main Results:
- Both procedures yielded an average of 8.1 quality-adjusted life years over 10 years.
- Average costs were $19,388 for SLAP repair and $16,619 for biceps tenodesis.
- Biceps tenodesis was associated with a 14% cost saving.
Conclusions:
- SLAP repair and biceps tenodesis offer comparable quality-adjusted life years and utility for type II SLAP tears in younger patients.
- Biceps tenodesis is more cost-effective, demonstrating significant cost savings.
- Findings support the role of biceps tenodesis in treating SLAP tears in this population.
Background:
The surgical management of type II superior labrum anterior and posterior (SLAP) tears in patients younger than 40 years is controversial, but growing evidence suggests comparable outcomes between primary SLAP repair and primary biceps tenodesis, with lower rates of reoperations after primary biceps tenodesis. Given the relatively similar patient-reported outcomes, cost-effectiveness analyses of direct and indirect costs associated with the two procedures propound a valuable comparative technique.
Hypothesis:
In this value-based comparison of SLAP repair versus biceps tenodesis, we hypothesized that biceps tenodesis would be more cost-effective than SLAP repair in patients younger than 40 years.
Study Design:
Economic and decision analysis; Level of evidence, 4.
Methods:
A 1-month Markov cycle was simulated to reflect 10 years of health outcomes. Health states were selected based on outcomes that are especially important in assessing indirect costs for a younger, active patient population: return-to-sport rates, which demonstrate a return to baseline function, and reoperation rates. Transition state probabilities were obtained through an index systematic review and meta-analysis comparing labral repair and biceps tenodesis for the treatment of type II SLAP lesions in patients younger than 40 years. Health state utility and cost values were obtained from accepted values denoted in existing literature.
Results:
Both primary SLAP repair and primary biceps tenodesis yielded an average expected 8.1 quality-adjusted life years over the 10-year period. The average cost (in 2021 US$) was $16,619 for biceps tenodesis and $19,388 for SLAP repair.
Conclusion:
In a younger patient population, SLAP repair and biceps tenodesis had comparable quality-adjusted life years and utility in the treatment of type II SLAP tears; however, SLAP repair cost $19,388, while biceps tenodesis cost $16,619, reflecting a 14% cost savings with biceps tenodesis. These findings can be extrapolated to further establish the role for these procedures in treating SLAP tears.