Duke Orthopaedic Surgery, 4709 Creekstone Drive, Suite 200, Durham, NC 27710.
J Bone Joint Surg Am. 2013 Nov 20;95(22):1993-2000. doi: 10.2106/JBJS.L.01495.
Although rotator cuff disease is a common musculoskeletal problem in the United States, the impact of this condition on earnings, missed workdays, and disability payments is largely unknown. This study examines the value of surgical treatment for full-thickness rotator cuff tears from a societal perspective.
A Markov decision model was constructed to estimate lifetime direct and indirect costs associated with surgical and continued nonoperative treatment for symptomatic full-thickness rotator cuff tears. All patients were assumed to have been unresponsive to one six-week trial of nonoperative treatment prior to entering the model. Model assumptions were obtained from the literature and data analysis. We obtained estimates of indirect costs using national survey data and patient-reported outcomes. Four indirect costs were modeled: probability of employment, household income, missed workdays, and disability payments. Direct cost estimates were based on average Medicare reimbursements with adjustments to an all-payer population. Effectiveness was expressed in quality-adjusted life years (QALYs).
The age-weighted mean total societal savings from rotator cuff repair compared with nonoperative treatment was $13,771 over a patient's lifetime. Savings ranged from $77,662 for patients who are thirty to thirty-nine years old to a net cost to society of $11,997 for those who are seventy to seventy-nine years old. In addition, surgical treatment results in an average improvement of 0.62 QALY. Societal savings were highly sensitive to age, with savings being positive at the age of sixty-one years and younger. The estimated lifetime societal savings of the approximately 250,000 rotator cuff repairs performed in the U.S. each year was $3.44 billion.
Rotator cuff repair for full-thickness tears produces net societal cost savings for patients under the age of sixty-one years and greater QALYs for all patients. Rotator cuff repair is cost-effective for all populations. The results of this study should not be interpreted as suggesting that all rotator cuff tears require surgery. Rather, the results show that rotator cuff repair has an important role in minimizing the societal burden of rotator cuff disease.
尽管肩袖疾病是美国常见的肌肉骨骼问题，但这种疾病对收入、旷工天数和残疾津贴的影响在很大程度上尚不清楚。本研究从社会角度探讨了全层肩袖撕裂的手术治疗价值。
构建了一个马尔可夫决策模型，以估计与手术和持续非手术治疗有症状的全层肩袖撕裂相关的终身直接和间接成本。所有患者在进入模型前都假定对非手术治疗的六周尝试没有反应。模型假设来自文献和数据分析。我们使用全国调查数据和患者报告的结果来估算间接成本。对四种间接成本进行建模：就业率、家庭收入、旷工天数和残疾津贴。直接成本估算基于平均医疗保险报销额，并根据所有支付者人群进行调整。效果以质量调整生命年（QALY）表示。
与非手术治疗相比，肩袖修复的全层撕裂的年龄加权平均总社会节省为每位患者终生 13771 美元。节省范围从 30 岁至 39 岁患者的 77662 美元到 70 岁至 79 岁患者的社会净成本 11997 美元。此外，手术治疗平均可提高 0.62 个 QALY。社会节省对年龄高度敏感，61 岁及以下的年龄节省为正。美国每年进行的大约 25 万次肩袖修复的估计终生社会节省为 34.4 亿美元。
对于 61 岁以下的患者，全层肩袖撕裂的修复可产生净社会成本节省，并为所有患者带来更大的 QALY。对于所有人群，肩袖修复都具有成本效益。本研究的结果不应被解释为表明所有肩袖撕裂都需要手术。相反，结果表明肩袖修复在最小化肩袖疾病的社会负担方面具有重要作用。
