Boston Shoulder Institute, Brigham and Women's Hospital, Boston, MA, USA.
Cooper Bone and Joint Institute, Camden, NJ, USA.
J Shoulder Elbow Surg. 2018 Jun;27(6S):S2-S9. doi: 10.1016/j.jse.2017.11.013. Epub 2018 Jan 4.
The purpose of this study was to conduct a cost-effectiveness analysis of the arthroscopic Bankart and the open Latarjet in the treatment of primary shoulder instability.
This cost-effectiveness study used a Markov decision chain and Monte-Carlo simulation. Existing literature was reviewed to determine the survivorship and complication rates of these procedures. Health utility states (EQ-5D and quality-adjusted life-years) of the Bankart and Latarjet were prospectively collected. Using these variables, the Monte-Carlo simulation was modeled 100,000 times.
In reviewing the literature, the overall recurrence rate is 14% after the arthroscopic Bankart and 8% after the open Latarjet. Postoperative health utility states were equal between the 2 procedures (mean EQ-5D, 0.930; P = .775). The Monte-Carlo simulation showed that the Bankart had an incremental cost-effectiveness ratio of $4214 and the Latarjet had an incremental cost-effectiveness ratio of $4681 (P < .001).
Both the arthroscopic Bankart and open Latarjet are highly cost-effective; however, the Bankart is more cost-effective than the Latarjet, primarily because of a lower health utility state after a failed Latarjet. Ultimately, the clinical scenario may favor Latarjet (ie, critical glenoid bone loss) in certain circumstances, and decisions should be made on a case by case basis.
本研究旨在对关节镜 Bankart 和开放 Latarjet 治疗原发性肩关节不稳定进行成本效果分析。
本成本效果研究采用 Markov 决策链和 Monte-Carlo 模拟。回顾现有文献，确定这些手术的存活率和并发症发生率。前瞻性收集 Bankart 和 Latarjet 的健康效用状态（EQ-5D 和质量调整生命年）。使用这些变量，对 Monte-Carlo 模拟进行了 10 万次建模。
在文献回顾中，关节镜 Bankart 后的总体复发率为 14%，开放 Latarjet 后的复发率为 8%。两种手术的术后健康效用状态相当（平均 EQ-5D，0.930；P=0.775）。Monte-Carlo 模拟显示 Bankart 的增量成本效果比为 4214 美元，Latarjet 的增量成本效果比为 4681 美元（P<0.001）。
关节镜 Bankart 和开放 Latarjet 均具有高度成本效果，但 Bankart 比 Latarjet 更具成本效果，主要是因为 Latarjet 失败后健康效用状态较低。最终，在某些情况下，临床情况可能有利于 Latarjet（即，临界肩胛盂骨丢失），应根据具体情况做出决策。
