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International Orthopaedics

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Open Access 01-02-2019 | Original Paper

Comparative cost-effectiveness analysis of the subacromial spacer for irreparable and massive rotator cuff tears

Authors: Alessandro Castagna, Raffaele Garofalo, Eran Maman, Alisha C. Gray, Elizabeth A. Brooks

Published in: International Orthopaedics | Issue 2/2019

Abstract

Purpose

There is ongoing debate regarding the optimal surgical treatment of irreparable rotator cuff tears (IRCT). This study aimed to assess within the Italian health care system the cost-effectiveness of subacromial spacer as a treatment modality for patients with IRCT.

Methods

An expected-value decision analysis was created comparing costs and outcomes of patients undergoing arthroscopic subacromial spacer implantation, rotator cuff repair (RCR), total shoulder arthroplasty, and conservative treatment for IRCTs. A broad literature search provided input data to extrapolate and inform treatment success and failure rates, costs, and health utility states for these outcomes. The primary outcome assessed was an incremental cost-effectiveness ratio (ICER) of subacromial spacer implantation versus shoulder arthroplasty, RCR, and conservative treatment.

Results

Subacromial spacer is favorable over both arthroscopic partial repair and shoulder arthroplasty since it costs less than both options and increases effectiveness by 0.06 and 0.10 quality-adjusted life years (QALYs), respectively. While conservative treatment is the least costly management strategy, subacromial spacer results in a gain of 0.05 QALYs for the additional cost of 522 €, resulting in an ICER of 10,440 €/QALY gain, which is below the standard willingness to pay ratio of $50,000 USD. Strategies with an ICER of less than 50,000 USD are considered to be cost-effective.

Conclusions

Based on the available evidence and reasonably conservative assumptions, subacromial spacer is likely to provide a safe, effective, and cost-effective option for patients with massive IRCTs. Furthermore, this cost-effectiveness analysis may ultimately serve as a guide for development of health care system and insurer policy as well as clinical practice.

Bedi A, Dines J, Warren RF, Dines DM (2010) Massive tears of the rotator cuff. J Bone Joint Surg Am 92(9):1894–1908. https://doi.org/10.2106/JBJS.I.01531 CrossRefPubMed

Cofield RH, Parvizi J, Hoffmeyer PJ, Lanzer WL, Ilstrup DM, Rowland CM (2001) Surgical repair of chronic rotator cuff tears. A prospective long-term study. J Bone Joint Surg Am 83-A(1):71–77CrossRef

Zumstein MA, Jost B, Hempel J, Hodler J, Gerber C (2008) The clinical and structural long-term results of open repair of massive tears of the rotator cuff. J Bone Joint Surg Am 90(11):2423–2431. https://doi.org/10.2106/JBJS.G.00677 CrossRefPubMed

Longo UG, Berton A, Papapietro N, Maffulli N, Denaro V (2012) Epidemiology, genetics and biological factors of rotator cuff tears. Med Sport Sci 57:1–9. https://doi.org/10.1159/000328868 CrossRefPubMed

Ainsworth R (2006) Physiotherapy rehabilitation in patients with massive, irreparable rotator cuff tears. Musculoskeletal Care 4(3):140–151. https://doi.org/10.1002/msc.85 CrossRefPubMed

Walch G, Edwards TB, Boulahia A, Nove-Josserand L, Neyton L, Szabo I (2005) Arthroscopic tenotomy of the long head of the biceps in the treatment of rotator cuff tears: clinical and radiographic results of 307 cases. J Shoulder Elb Surg 14(3):238–246. https://doi.org/10.1016/j.jse.2004.07.008 CrossRef

Sanchez-Sotelo J, Cofield RH, Rowland CM (2001) Shoulder hemiarthroplasty for glenohumeral arthritis associated with severe rotator cuff deficiency. J Bone Joint Surg Am 83-A(12):1814–1822CrossRef

Wall B, Nove-Josserand L, O’Connor DP, Edwards TB, Walch G (2007) Reverse total shoulder arthroplasty: a review of results according to etiology. J Bone Joint Surg Am 89(7):1476–1485. https://doi.org/10.2106/JBJS.F.00666 CrossRefPubMed

Young SW, Zhu M, Walker CG, Poon PC (2013) Comparison of functional outcomes of reverse shoulder arthroplasty with those of hemiarthroplasty in the treatment of cuff-tear arthropathy: a matched-pair analysis. J Bone Joint Surg Am 95(10):910–915. https://doi.org/10.2106/JBJS.L.00302 CrossRefPubMed

10.

Zumstein MA, Pinedo M, Old J, Boileau P (2011) Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elb Surg 20(1):146–157. https://doi.org/10.1016/j.jse.2010.08.001 CrossRef

11.

Savarese E, Romeo R (2012) New solution for massive, irreparable rotator cuff tears: the subacromial “biodegradable spacer”. Arthrosc Tech 1(1):e69–e74. https://doi.org/10.1016/j.eats.2012.02.002 CrossRefPubMedPubMedCentral

12.

Gervasi E, Cautero E, Dekel A (2014) Fluoroscopy-guided implantation of subacromial “biodegradable spacer” using local anesthesia in patients with irreparable rotator cuff tear. Arthrosc Tech 3(4):e455–e458. https://doi.org/10.1016/j.eats.2014.05.010 CrossRefPubMedPubMedCentral

13.

Longo UG, Salvatore G, Rizzello G, Berton A, Ciuffreda M, Candela V, Denaro V (2017) The burden of rotator cuff surgery in Italy: a nationwide registry study. Arch Orthop Trauma Surg 137(2):217–224. https://doi.org/10.1007/s00402-016-2610-x CrossRefPubMed

14.

Kang JR, Sin AT, Cheung EV (2017) Treatment of massive irreparable rotator cuff tears: a cost-effectiveness analysis. Orthopedics 40(1):e65–e76. https://doi.org/10.3928/01477447-20160926-06 CrossRefPubMed

15.

Makhni EC, Swart E, Steinhaus ME, Mather RC 3rd, Levine WN, Bach BR Jr, Romeo AA, Verma NN (2016) Cost-effectiveness of reverse total shoulder arthroplasty versus arthroscopic rotator cuff repair for symptomatic large and massive rotator cuff tears. Arthroscopy 32(9):1771–1780. https://doi.org/10.1016/j.arthro.2016.01.063 CrossRefPubMed

16.

Gervasi E, Maman E, Dekel A, Cautero E (2016) Fluoroscopy-guided biodegradable spacer implantation using local anesthesia: safety and efficacy study in patients with massive rotator cuff tears. Musculoskelet Surg 100(1):19–24. https://doi.org/10.1007/s12306-016-0433-0 CrossRefPubMedPubMedCentral

17.

Senekovic V, Poberaj B, Kovacic L, Mikek M, Adar E, Markovitz E, Maman E, Dekel A (2017) The biodegradable spacer as a novel treatment modality for massive rotator cuff tears: a prospective study with 5-year follow-up. Arch Orthop Trauma Surg 137(1):95–103. https://doi.org/10.1007/s00402-016-2603-9 CrossRefPubMed

Title: Comparative cost-effectiveness analysis of the subacromial spacer for irreparable and massive rotator cuff tears
Authors: Alessandro Castagna
Raffaele Garofalo
Eran Maman
Alisha C. Gray
Elizabeth A. Brooks
Publication date: 01-02-2019
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 2/2019
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-018-4065-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Comparative cost-effectiveness analysis of the subacromial spacer for irreparable and massive rotator cuff tears

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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