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

• DOI: 10.1007/s00264-018-4065-x
• Publication Date: 2018-07-31T06:59:55Z
• Authors: Alessandro Castagna; Raffaele Garofalo; Eran Maman; Alisha C. Gray; Elizabeth A. Brooks
• Keywords: Conservative Management; Subacromial impingement; Conservative Treatment

There is ongoing debate regarding the optimal surgical treatment of irreparable rotator cuff tears (IRCT). This study aimed to assess within Italian health care system cost-effectiveness subacromial spacer as a modality for patients with IRCT. An expected-value decision analysis was created comparing costs and outcomes undergoing arthroscopic implantation, repair (RCR), total shoulder arthroplasty, conservative IRCTs. A broad literature search provided input data extrapolate inform success failure rates, costs, utility states these outcomes. The primary outcome assessed an incremental ratio (ICER) implantation versus RCR, treatment. Subacromial favorable over both partial arthroplasty since it less than options increases effectiveness by 0.06 0.10 quality-adjusted life years (QALYs), respectively. While least costly management strategy, results in gain 0.05 QALYs additional cost 522 €, resulting ICER 10,440 €/QALY gain, which below standard willingness pay $50,000 USD. Strategies 50,000 USD are considered be cost-effective. Based on available evidence reasonably assumptions, likely provide safe, effective, cost-effective option massive Furthermore, this may ultimately serve guide development insurer policy well clinical practice.