Cost-Effectiveness of Reverse Total Shoulder Arthroplasty Versus Arthroscopic Rotator Cuff REpair of Symptomatic Large and Massive Rotator Cuff Tears
The goal of this study was to compare the cost-effectiveness within the United States healthcare system of arthroscopic rotator cuff repair versus reverse total shoulder arthroplasty in patients with symptomatic large and massive rotator cuff tears without cuff-tear arthropathy.
An expected-value decision analysis was constructed comparing the costs and outcomes of patients undergoing arthroscopic rotator cuff repair and reverse total shoulder arthroplasty for large and massive rotator cuff tears. Comprehensive literature search provided input data to extrapolate costs and health utility states for these outcomes.
Arthroscopic rotator cuff repair was the preferred strategy, superior to non-operative care, with an incremental cost effectiveness ratio (ICER) of $15,500 / quality adjusted life year (QALY), and dominant over primary reverse total shoulder arthroplasty. The results in favor of arthroscopic rotator cuff repair as the dominant strategy held as long as the lifetime progression rate from re-tear to end-stage cuff-tear arthropathy was less than 89%.
Arthroscopic rotator cuff repair – despite high rates of tendon re-tearing – for patients with large and massive rotator cuff tears presents as a more cost-effective initial treatment strategy when compared to primary reverse total shoulder arthroplasty.