The Steadman Hawkins Clinic-Denver, CO 80124, USA.
J Bone Joint Surg Am. 2012 Aug 1;94(15):1369-77. doi: 10.2106/JBJS.J.01876.
Interest in double-row techniques for arthroscopic rotator cuff repair has increased over the last several years, presumably because of a combination of literature demonstrating superior biomechanical characteristics and recent improvements in instrumentation and technique. As a result of the increasing focus on value-based health-care delivery, orthopaedic surgeons must understand the cost implications of this practice. The purpose of this study was to examine the cost-effectiveness of double-row arthroscopic rotator cuff repair compared with traditional single-row repair.
A decision-analytic model was constructed to assess the cost-effectiveness of double-row arthroscopic rotator cuff repair compared with single-row repair on the basis of the cost per quality-adjusted life year gained. Two cohorts of patients (one with a tear of <3 cm and the other with a tear of ≥3 cm) were evaluated. Probabilities for retear and persistent symptoms, health utilities for the particular health states, and the direct costs for rotator cuff repair were derived from the orthopaedic literature and institutional data.
The incremental cost-effectiveness ratio for double-row compared with single-row arthroscopic rotator cuff repair was $571,500 for rotator cuff tears of <3 cm and $460,200 for rotator cuff tears of ≥3 cm. The rate of radiographic or symptomatic retear alone did not influence cost-effectiveness results. If the increase in the cost of double-row repair was less than $287 for small or moderate tears and less than $352 for large or massive tears compared with the cost of single-row repair, then double-row repair would represent a cost-effective surgical alternative.
On the basis of currently available data, double-row rotator cuff repair is not cost-effective for any size rotator cuff tears. However, variability in the values for costs and probability of retear can have a profound effect on the results of the model and may create an environment in which double-row repair becomes the more cost-effective surgical option. The identification of the threshold values in this study may help surgeons to determine the most cost-effective treatment.
近年来，关节镜下肩袖修补的双排技术越来越受到关注，这可能是由于文献中显示出的优越生物力学特性以及器械和技术的近期改进的综合作用。由于对基于价值的医疗保健服务的关注度不断提高，矫形外科医生必须了解这种做法的成本影响。本研究的目的是检查双排关节镜下肩袖修复与传统单排修复相比的成本效益。
基于获得的每质量调整生命年的成本，构建决策分析模型来评估双排关节镜下肩袖修复与单排修复的成本效益。评估了两组患者（一组撕裂<3cm，另一组撕裂≥3cm）。再撕裂和持续症状的概率、特定健康状态的健康效用以及肩袖修复的直接成本均源自矫形外科文献和机构数据。
对于撕裂<3cm 的肩袖，双排与单排关节镜肩袖修复相比，增量成本效益比为 571500 美元；对于撕裂≥3cm 的肩袖，增量成本效益比为 460200 美元。仅放射学或症状性再撕裂的发生率并不能影响成本效益结果。如果与单排修复相比，双排修复的成本增加小于小型或中型撕裂的 287 美元，或大型或巨大撕裂的 352 美元，那么双排修复将成为一种具有成本效益的手术选择。
根据目前可用的数据，双排肩袖修复对于任何大小的肩袖撕裂都不具有成本效益。然而，成本和再撕裂概率的变化值可能会对模型结果产生深远的影响，并可能使双排修复成为更具成本效益的手术选择。本研究中确定的阈值值可以帮助外科医生确定最具成本效益的治疗方法。
