Which treatment strategy for irreparable rotator cuff tears is most cost‐effective? A Markov model‐based cost‐utility analysis comparing superior capsular reconstruction, lower trapezius tendon transfer, subacromial balloon spacer implantation and reverse shoulder arthroplasty
Abstract Purpose Treatment options for irreparable rotator cuff tears (IRCTs) remain controversial and include superior capsular reconstruction (SCR), lower trapezius tendon transfer (LTTT), subacromial balloon spacer (SABS), and reverse shoulder arthroplasty (RSA). Despite reports of positive treat...
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| Language: | English |
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Wiley
2025-01-01
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| Series: | Journal of Experimental Orthopaedics |
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| Online Access: | https://doi.org/10.1002/jeo2.70180 |
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| author | Jacob F. Oeding Kyle N. Kunze Ayoosh Pareek Kristian Samuelsson |
| author_facet | Jacob F. Oeding Kyle N. Kunze Ayoosh Pareek Kristian Samuelsson |
| author_sort | Jacob F. Oeding |
| collection | DOAJ |
| description | Abstract Purpose Treatment options for irreparable rotator cuff tears (IRCTs) remain controversial and include superior capsular reconstruction (SCR), lower trapezius tendon transfer (LTTT), subacromial balloon spacer (SABS), and reverse shoulder arthroplasty (RSA). Despite reports of positive treatment responses with all approaches, the relative clinical benefit in the context of associated cost has not been well delineated. The purpose of this study was to determine the most cost‐effective treatment strategy among SCR, LTTT, SABS, and RSA for patients with massive IRCTs. Methods A Markov Chain Monte Carlo probabilistic model was developed to evaluate the outcomes and costs of 1000 simulated patients undergoing either SCR, LTTT, SABS, or RSA for massive IRCTs. Upfront costs, health utility values, and reoperation rates including revisions and conversion to RSA were derived from the published literature. Outcome measures included costs, quality‐adjusted life years (QALYs), and the incremental cost‐effectiveness ratio (ICER). Results Mean total costs of SCR, RSA, LTTT, and SABS were $30,540 ± 5,770, $26,896 ± 5,622, $25,819 ± 4,325, and $16,412 ± 2,583, respectively. On average, total QALYs from SCR, RSA, LTTT, and SABS were 6.17 ± 0.53, 3.78 ± 0.38, 5.33 ± 0.49, and 5.59 ± 0.48. Overall, SCR was determined the preferred, most cost‐effective strategy in 60% of patients included in the microsimulation model, with SABS the optimal strategy in 31% of cases and LTTT the optimal strategy in 9% of cases. Conclusion SCR was found to be the most cost‐effective treatment option for IRCTs based on the current microsimulation and probabilistic sensitivity analyses, although LTTT and SABS were also found to be cost‐effective in select patients. Given that this statistical model does not consider the unique experiences of individual patients, shared decision‐making remains an important component in determining the optimal treatment strategy for IRCTs. Level of Evidence Level III, economic decision model. |
| format | Article |
| id | doaj-art-2eee818d7c2e40eabde84caf9bf24f62 |
| institution | Kabale University |
| issn | 2197-1153 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wiley |
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| series | Journal of Experimental Orthopaedics |
| spelling | doaj-art-2eee818d7c2e40eabde84caf9bf24f622025-08-20T03:47:36ZengWileyJournal of Experimental Orthopaedics2197-11532025-01-01121n/an/a10.1002/jeo2.70180Which treatment strategy for irreparable rotator cuff tears is most cost‐effective? A Markov model‐based cost‐utility analysis comparing superior capsular reconstruction, lower trapezius tendon transfer, subacromial balloon spacer implantation and reverse shoulder arthroplastyJacob F. Oeding0Kyle N. Kunze1Ayoosh Pareek2Kristian Samuelsson3Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy University of Gothenburg Gothenburg SwedenDepartment of Orthopaedic Surgery Hospital for Special Surgery New York New York USADepartment of Orthopaedic Surgery Hospital for Special Surgery New York New York USADepartment of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy University of Gothenburg Gothenburg SwedenAbstract Purpose Treatment options for irreparable rotator cuff tears (IRCTs) remain controversial and include superior capsular reconstruction (SCR), lower trapezius tendon transfer (LTTT), subacromial balloon spacer (SABS), and reverse shoulder arthroplasty (RSA). Despite reports of positive treatment responses with all approaches, the relative clinical benefit in the context of associated cost has not been well delineated. The purpose of this study was to determine the most cost‐effective treatment strategy among SCR, LTTT, SABS, and RSA for patients with massive IRCTs. Methods A Markov Chain Monte Carlo probabilistic model was developed to evaluate the outcomes and costs of 1000 simulated patients undergoing either SCR, LTTT, SABS, or RSA for massive IRCTs. Upfront costs, health utility values, and reoperation rates including revisions and conversion to RSA were derived from the published literature. Outcome measures included costs, quality‐adjusted life years (QALYs), and the incremental cost‐effectiveness ratio (ICER). Results Mean total costs of SCR, RSA, LTTT, and SABS were $30,540 ± 5,770, $26,896 ± 5,622, $25,819 ± 4,325, and $16,412 ± 2,583, respectively. On average, total QALYs from SCR, RSA, LTTT, and SABS were 6.17 ± 0.53, 3.78 ± 0.38, 5.33 ± 0.49, and 5.59 ± 0.48. Overall, SCR was determined the preferred, most cost‐effective strategy in 60% of patients included in the microsimulation model, with SABS the optimal strategy in 31% of cases and LTTT the optimal strategy in 9% of cases. Conclusion SCR was found to be the most cost‐effective treatment option for IRCTs based on the current microsimulation and probabilistic sensitivity analyses, although LTTT and SABS were also found to be cost‐effective in select patients. Given that this statistical model does not consider the unique experiences of individual patients, shared decision‐making remains an important component in determining the optimal treatment strategy for IRCTs. Level of Evidence Level III, economic decision model.https://doi.org/10.1002/jeo2.70180cost‐effectivenessirreparable rotator cuff tearMarkov modelreverse shoulder arthroplastysuperior capsular reconstruction |
| spellingShingle | Jacob F. Oeding Kyle N. Kunze Ayoosh Pareek Kristian Samuelsson Which treatment strategy for irreparable rotator cuff tears is most cost‐effective? A Markov model‐based cost‐utility analysis comparing superior capsular reconstruction, lower trapezius tendon transfer, subacromial balloon spacer implantation and reverse shoulder arthroplasty Journal of Experimental Orthopaedics cost‐effectiveness irreparable rotator cuff tear Markov model reverse shoulder arthroplasty superior capsular reconstruction |
| title | Which treatment strategy for irreparable rotator cuff tears is most cost‐effective? A Markov model‐based cost‐utility analysis comparing superior capsular reconstruction, lower trapezius tendon transfer, subacromial balloon spacer implantation and reverse shoulder arthroplasty |
| title_full | Which treatment strategy for irreparable rotator cuff tears is most cost‐effective? A Markov model‐based cost‐utility analysis comparing superior capsular reconstruction, lower trapezius tendon transfer, subacromial balloon spacer implantation and reverse shoulder arthroplasty |
| title_fullStr | Which treatment strategy for irreparable rotator cuff tears is most cost‐effective? A Markov model‐based cost‐utility analysis comparing superior capsular reconstruction, lower trapezius tendon transfer, subacromial balloon spacer implantation and reverse shoulder arthroplasty |
| title_full_unstemmed | Which treatment strategy for irreparable rotator cuff tears is most cost‐effective? A Markov model‐based cost‐utility analysis comparing superior capsular reconstruction, lower trapezius tendon transfer, subacromial balloon spacer implantation and reverse shoulder arthroplasty |
| title_short | Which treatment strategy for irreparable rotator cuff tears is most cost‐effective? A Markov model‐based cost‐utility analysis comparing superior capsular reconstruction, lower trapezius tendon transfer, subacromial balloon spacer implantation and reverse shoulder arthroplasty |
| title_sort | which treatment strategy for irreparable rotator cuff tears is most cost effective a markov model based cost utility analysis comparing superior capsular reconstruction lower trapezius tendon transfer subacromial balloon spacer implantation and reverse shoulder arthroplasty |
| topic | cost‐effectiveness irreparable rotator cuff tear Markov model reverse shoulder arthroplasty superior capsular reconstruction |
| url | https://doi.org/10.1002/jeo2.70180 |
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