McIntyre Louis F, Nherera Leo M, Schlegel Theodore F
United States Orthopedic Partners, White Plains, New York, U.S.A.
Smith & Nephew, Fort Worth, Texas, U.S.A.
Arthrosc Sports Med Rehabil. 2023 Feb 11;5(2):e367-e374. doi: 10.1016/j.asmr.2023.01.002. eCollection 2023 Apr.
This study was conducted to investigate whether the use of resorbable bioinductive collagen implant (RBI) in addition to conventional rotator cuff repair (conventional RCR) is cost-effective when compared to conventional RCR alone, in the treatment of full-thickness rotator cuff tears (FT RCT).
We developed a decision analytic model to compare the expected incremental cost and clinical consequences for a cohort of patients with FT RCT. The probabilities for healing or failure to heal (retear) were estimated from the published literature. Implant and healthcare costs were estimated from a payor's perspective in 2021 U.S. prices. An additional analysis included indirect cost estimations (e.g., productivity losses). Sensitivity analyses explored the effect of tear size, as well as the impact of risk factors.
The base case analysis demonstrated that resorbable bioinductive collagen implant + conventional rotator cuff repair results in incremental costs of $232,468 and an additional 18 healed RCTs per 100 treated patients over 1 year. The estimated incremental cost-effectiveness ratio (ICER) is $13,061/healed RCT compared to conventional RCR alone. When return to work was included in the model, RBI + conventional RCR was found to be cost saving. Cost-effectiveness improved with tear size with the largest benefit seen in massive tears compared to large tears, as well as patients at higher risk of retearing.
This economic analysis demonstrated that RBI + conventional RCR delivered improved healing rates at a marginal increase in costs when compared to conventional RCR alone and is, therefore, cost-effective in this patient population. Considering indirect costs, RBI + conventional RCR resulted in lower costs compared to conventional RCR alone and is, therefore, deemed to be cost saving.
Level IV, economic analysis.
本研究旨在探讨在治疗全层肩袖撕裂（FT RCT）时，与单纯传统肩袖修复术（传统RCR）相比，使用可吸收生物诱导胶原蛋白植入物（RBI）联合传统肩袖修复术是否具有成本效益。
我们建立了一个决策分析模型，以比较一组FT RCT患者的预期增量成本和临床后果。愈合或未愈合（再撕裂）的概率根据已发表的文献进行估计。植入物和医疗保健成本从支付方的角度以2021年美国价格进行估计。另一项分析包括间接成本估计（例如生产力损失）。敏感性分析探讨了撕裂大小的影响以及风险因素的影响。
基础病例分析表明，可吸收生物诱导胶原蛋白植入物 + 传统肩袖修复术导致增量成本为232,468美元，每100名接受治疗的患者在1年内额外有18例RCT愈合。与单纯传统RCR相比，估计的增量成本效益比（ICER）为13,061美元/愈合的RCT。当模型中纳入重返工作时，发现RBI + 传统RCR具有成本节约效果。成本效益随着撕裂大小的增加而提高，与大撕裂相比，在巨大撕裂以及再撕裂风险较高的患者中获益最大。
这项经济分析表明，与单纯传统RCR相比，RBI + 传统RCR在成本略有增加的情况下提高了愈合率，因此在该患者群体中具有成本效益。考虑到间接成本，RBI + 传统RCR与单纯传统RCR相比成本更低，因此被认为具有成本节约效果。
IV级，经济分析。
