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Study: Re-revision arthroscopic rotator cuff repair may not be cost effective
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SAN ANTONIO — Re-repair of the rotator cuff after arthroscopic surgery or re-revision for failure of arthroscopic rotator cuff surgery is not cost effective, according to a study presented at the Arthroscopy Association of North America Annual Meeting, here.
“Rotator cuff repair is cost effective when only primary rotator cuff repair is performed,” Laurence D. Higgins, MD, said. “Revision surgery is cost effective if it does not involve re-repair and any failure where re-revision surgery involves repairing the cuff is not cost effective.”
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In the study, Higgins and his team used a cost-effectiveness utilities model and model input parameters from published literature, which included mean failure, infection, nerve injury and stiffness rate. They included studies with minimum 2-year follow-up and calculated health utility scores using the SF-36. They used average life expectancies to arrive at cost-effectiveness ratios. Data from the literature included overall hospital costs, physical therapy, physician appointments and additional procedures for revision or complications. A cost of $50,000 was set as the limit for a cost-effective procedure.
Laurence D. Higgins
The quality adjusted life years for rotator cuff surgery was 1.71 with no complications, 1.46 with complications and 1.22 for revision rotator cuff surgery. Rotator cuff repair cost an estimated $7,000; revision rotator cuff repair cost $58,000; failed rotator cuff repair with revision cost $117,000; and rotator cuff repair with complication and early surgical intervention cost $20,000.
Reference:
Higgins L. Paper #SS-28. Presented at: Arthroscopy Association of North America Annual Meeting; April 25-27, 2013; San Antonio.
Disclosures: Higgins receives fellowship support from Arthrex Inc., Smith & Nephew, Breg, DePuy and Johnson & Johnson.