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Cost-Effectiveness of Rotator Cuff Repair With Concomitant Subacromial Decompression at Mid-Term Follow-Up: A
Rodrigo Saad Berreta1, Daniel Badin, Henry Fox
1From the Department of Orthopedics, Johns Hopkins University School of Medicine, Baltimore, MD (Saad Berreta, Badin, Fox, Koyejo, Mian, Sundaresh, Siragusa, Ashkar, Harris, Chan, Jain, and Srikumaran); Hopkins Business of Health Initiative (HBHI), Johns Hopkins University Carey Business School, Baltimore, MD (Jain and Srikumaran).
Adding subacromial decompression (SAD) to rotator cuff repair (RCR) for full-thickness tears is cost-effective. This combined approach offers greater quality-adjusted life years (QALYs) and lower overall costs compared to RCR alone.
Area of Science:
- Orthopedic Surgery
- Health Economics
- Clinical Decision Analysis
Background:
- Limited evidence exists on the cost-effectiveness of adding subacromial decompression (SAD) to rotator cuff repair (RCR).
- This is crucial for treating full-thickness rotator cuff tears.
Purpose of the Study:
- To systematically review and conduct a cost-utility analysis.
- To compare isolated RCR versus RCR with SAD for full-thickness rotator cuff tears.
Main Methods:
- Systematic review (PRISMA 2020) of Level I-II studies with ≥5-year follow-up.
- Decision tree model for cost-effectiveness over 5 years, using literature-derived costs, revision rates, and EQ-5D utility values (QALYs).
- Analysis included incremental cost-effectiveness ratios, net monetary benefit (NMB), and sensitivity analyses.
Main Results:
- RCR with SAD had lower mean costs ($33,448 vs $34,593) and higher QALYs (1.465 vs 1.454) over 5 years.
- RCR + SAD was the dominant strategy with positive NMB ($1,695) and negative incremental cost-effectiveness ratio.
- Sensitivity analyses confirmed RCR + SAD's cost-effectiveness under various parameters.
Conclusions:
- Subacromial decompression during rotator cuff repair is cost-effective at mid-term follow-up.
- The addition of SAD reduces revision rates, leading to better QALYs and lower overall costs than isolated RCR.
