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Double-row arthroscopic rotator cuff repair found not cost-effective
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Arthroscopic double-row rotator cuff (RC) repair was found not cost-effective for RC tears of any size vs. arthroscopic single-row procedures based on results of this study. However, variability in the values for costs used and the probability of retear could mean double-row repairs may eventually prove to be the more cost-effective of the two treatments, the authors noted.
For their study, researchers used a decision analytic model designed to assess the cost-effectiveness of arthroscopic double-row arthroscopic RC repair compared to arthroscopic single-row RC repair on the basis of cost per quality adjusted life year (QALY) gained. They studied two cohorts of patients with single RC tears; one group’s tears were sized less than 3 cm and the other group’s tears were 3 cm or more in size. Both groups were deemed appropriate candidates for arthroscopic reconstruction.
Using the orthopedic literature and institutional data, the authors derived probabilities for retear and persistent symptoms, and health utilities for the particular health states, as well as direct costs for arthroscopic RC repair surgery.
Single-row RC repair was less costly than double-row repair for RC tears less than 3 cm, as well as for tears greater than or equal to 3 cm, the base case analysis results showed. Based on cost alone, double-row reconstruction resulted in an increased overall cost of $1,238 for cuff tears less than 3 cm and $1,222 for tears sized 3 cm or greater. The increased effectiveness the researchers found for tears treated with double-row procedures was 0.0022 QALY for the smallest tears treated and 0.0027 QALY for tears equal to or greater than 3 cm.
Based on this study, the increase in the cost of double-row RC repair would need to be less than $287 for small or moderate tears or less than $352 for large or massive tears for that procedure to be a cost-effective option, the authors noted.
Rates of radiographic or symptomatic retear alone did not influence cost-effectiveness results, they noted in the study.
“With use of current data for the average patient presenting with a rotator cuff tear, irrespective of tear size, double-row repair is not a cost-effective method of rotator cuff repair. The incremental cost associated with a second row of implants and associated operating-room time is not offset by the reduction in retear proportions, the potential improved clinical rate or the potential decreased need for revision surgery. There are, however, specific clinical scenarios of primary injuries with higher retear proportions of persistent symptoms that would justify some additional costs,” the researchers stated in the study. “The challenge of future research is to identify characteristics of rotator cuff tears that would best be suited for this added expense.”
Disclosure: The researchers reported no relevant financial disclosures.
Perspective
Back to TopJoshua Dines, MD
The role of single- vs. double-row rotator cuff repairs has been debated heavily over the last 5 years without any clear consensus as to what is better for the patient. Patient age, size/chronicity/location of the tear, and biology are all important variables with regard to tendon healing and clinical outcome after repair and should all be taken into account when deciding upon the best repair construct for a given individual. The authors of this study should be commended for doing an outstanding job analyzing another one of the important variables associated with rotator cuff repairs: cost. Based on their results, double row repairs were not cost-effective. The authors did caution that some cases may justify the additional cost, however, and this remains the key element to achieving successful outcomes for our patients: determining what construct would provide the best outcome for each individual case.
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