Mather and colleagues estimated whether rotator cuff repair for symptomatic full‑thickness tears saves society money over continued nonoperative care once lost earnings, missed work and disability payments are counted.
Markov cost‑effectiveness model of a US cohort representative of annual repairs (base‑case mean age 56), funded by the AAOS, NIH and National Cancer Institute.
Key Findings
Over a lifetime, repair saved society a mean $13,771 per patient vs nonoperative care, counting direct and indirect costs, and added a mean 0.62 QALY.
Repair was dominant, both cheaper and more effective, for patients under 61. Savings were largest at ages 30 to 39, at $77,662 per patient.
Over 61, repair cost society more than nonoperative care, a net $11,997 per patient at ages 70 to 79. It stayed below the $50,000 per QALY threshold, at $12,024 per QALY for ages 60 to 69 and $36,576 for 70 to 79.
Repair was the preferred strategy in 72.2% of probabilistic samples but in only 48% of individual‑patient microsimulation trials. The authors suggest the other 52% are likely nonoperative responders or symptomatic retears.
The authors judged nonoperative success the most influential input on cost‑effectiveness: repair stayed cost‑effective unless it exceeded 90%. Societal savings broke even at 88% nonoperative success vs the 68% base case, which the authors note lies outside reported values.
Inputs came from the literature or, where data were lacking, the opinion of 5 surgeons, and progression to arthropathy was not modeled. The authors urge caution in using the results to guide individual patients.
Board pearl
Without indirect costs, repair was cost‑effective but not cost‑saving. Under 61, lower indirect costs after repair more than offset its higher direct costs.
Authors' conclusion
Rotator cuff repair for full-thickness tears produces net societal cost savings for patients under the age of 61 years and greater QALYs for all patients. Rotator cuff repair is cost-effective for all populations. The results of this study should not be interpreted as suggesting that all rotator cuff tears require surgery. Rather, the results show that rotator cuff repair has an important role in minimizing the societal burden of rotator cuff disease.
Mather and colleagues estimated whether rotator cuff repair for symptomatic full‑thickness tears saves society money over continued nonoperative care once lost earnings, missed work and disability payments are counted.
Markov cost‑effectiveness model of a US cohort representative of annual repairs (base‑case mean age 56), funded by the AAOS, NIH and National Cancer Institute.
Key Findings
Over a lifetime, repair saved society a mean $13,771 per patient vs nonoperative care, counting direct and indirect costs, and added a mean 0.62 QALY.
Repair was dominant, both cheaper and more effective, for patients under 61. Savings were largest at ages 30 to 39, at $77,662 per patient.
Over 61, repair cost society more than nonoperative care, a net $11,997 per patient at ages 70 to 79. It stayed below the $50,000 per QALY threshold, at $12,024 per QALY for ages 60 to 69 and $36,576 for 70 to 79.
Repair was the preferred strategy in 72.2% of probabilistic samples but in only 48% of individual‑patient microsimulation trials. The authors suggest the other 52% are likely nonoperative responders or symptomatic retears.
The authors judged nonoperative success the most influential input on cost‑effectiveness: repair stayed cost‑effective unless it exceeded 90%. Societal savings broke even at 88% nonoperative success vs the 68% base case, which the authors note lies outside reported values.
Inputs came from the literature or, where data were lacking, the opinion of 5 surgeons, and progression to arthropathy was not modeled. The authors urge caution in using the results to guide individual patients.
Board pearl
Without indirect costs, repair was cost‑effective but not cost‑saving. Under 61, lower indirect costs after repair more than offset its higher direct costs.
Authors' conclusion
Rotator cuff repair for full-thickness tears produces net societal cost savings for patients under the age of 61 years and greater QALYs for all patients. Rotator cuff repair is cost-effective for all populations. The results of this study should not be interpreted as suggesting that all rotator cuff tears require surgery. Rather, the results show that rotator cuff repair has an important role in minimizing the societal burden of rotator cuff disease.