Department of Orthopaedic Surgery, Leicester General Hospital, Leicester, United Kingdom.
J Shoulder Elbow Surg. 2010 Mar;19(2):258-61. doi: 10.1016/j.jse.2009.05.004. Epub 2009 Jul 1.
Economic evaluation of surgical procedures is necessary in view of more expensive newer techniques emerging in an increasingly cost-conscious health care environment. This study compares the cost-effectiveness of open rotator cuff repair with arthroscopic repair for moderately size tears.
This was a prospective study of 30 consecutive patients, of whom 15 had an arthroscopic repair and 15 had an open procedure. Clinical effectiveness was assessed using Oxford and Constant shoulder scores. Costs were estimated from departmental and hospital financial data.
At last follow-up, no difference Oxford and Constant shoulder scores was noted between the 2 methods of repair. There was no significant difference between the groups in the cost of time in the operating theater, inpatient time, amount of postoperative analgesia, number of postoperative outpatient visits, physiotherapy costs, and time off work. The incremental cost of each arthroscopic rotator cuff repair was pound675 ($1248.75) more than the open procedure. This was mainly in the area of direct health care costs, instrumentation in particular.
Health care policy makers are increasingly demanding evidence of cost-effectiveness of a procedure. This study showed both methods of repair provide equivalent clinical results.
Open cuff repair is more cost-effective than arthroscopic repair and is likely to have lower cost-utility ratio. In addition, the tariff for the arthroscopic procedure in some health care systems is same as open repair.
在日益注重成本的医疗保健环境下，新出现的昂贵新技术层出不穷，因此有必要对手术程序进行经济评估。本研究比较了开放性肩袖修复术与关节镜修复术治疗中等大小撕裂的成本效益。
这是一项前瞻性研究，共纳入 30 例连续患者，其中 15 例行关节镜修复术，15 例行开放性手术。采用牛津和康斯腾肩部评分评估临床疗效。成本由科室和医院财务数据估算。
末次随访时，两种修复方法的牛津和康斯腾肩部评分无差异。两组在手术室时间、住院时间、术后镇痛量、术后门诊次数、物理治疗费用和停工时间方面无显著差异。与开放性手术相比，每例关节镜肩袖修复术的增量成本为 675 英镑（1248.75 美元）。这主要是在直接医疗成本方面，尤其是器械方面。
医疗保健政策制定者越来越要求提供程序成本效益的证据。本研究表明，两种修复方法均能提供等效的临床结果。
开放性肩袖修复术比关节镜修复术更具成本效益，且可能具有更低的成本效用比。此外，在某些医疗保健系统中，关节镜手术的费用与开放性修复相同。
