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Cost-effectiveness of open biceps tenodesis for superior labral tears in patients younger than 30 years: a Markov
Eoghan T Hurley1, Jacob F Oeding1, Mark A Glover1
1Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC, USA.
Background:
Biceps tenodesis (BT) has emerged as an alternative to arthroscopic labral repair (ALR) in younger patients with superior labral anterior-posterior (SLAP) tears. The purpose of this study is to perform a Markov model-based cost-effectiveness analysis comparing BT to ALR for symptomatic SLAP tears in patients <30 years old, using return to play (RTP) as the primary measure of surgical utility.
Methods:
Both deterministic and Markov-chain Monte Carlo probabilistic models were developed to evaluate the outcomes and costs of 100 simulated patients (<30 years old) undergoing BT vs. ALR for symptomatic, SLAP tears. Surgical failure rates, RTP rates, and costs were derived from the published literature and varied through probabilistic sensitivity analyses. Outcome measures included costs, acquired duty years (DYs; annual participation in full physical activity-including sport, military service, or occupational work-without the limitations imposed by revision surgery or treatment failure), and the incremental cost-effectiveness ratio. Ten-year costs for each patient in the microsimulation model were averaged by initial treatment strategy, capturing subsequent treatments patients underwent because of reoperation.
Results:
Over the 10-year time horizon, results from the deterministic model demonstrated total costs resulting from BT and ALR of $35,402 and $40,960, respectively. In addition, BT was associated with 5.39 DYs gained, compared with 5.05 DYs gained for ALR. These results were replicated in the probabilistic model, demonstrating BT to be the preferred, cost-effective treatment strategy, with both lower costs and higher DYs acquired as a result of undergoing BT.
Conclusion:
Results of both the deterministic model and Monte Carlo microsimulation and probabilistic sensitivity analysis demonstrated BT to be the dominant, cost-effective treatment strategy for symptomatic SLAP tears in patients <30 years of age, measured via both lower costs and significant, but marginally higher, DYs.