The Open Latarjet is More Cost-Effective than Arthroscopic Bankart Repair for First-Time Shoulder Dislocations in Male Patients with < 10% Glenoid Bone-Loss.

Abstract

Purpose: The purpose of this study is to perform a Markov model-based cost-effectiveness analysis comparing arthroscopic Bankart repair (ABR) to open Latarjet for first-time shoulder dislocations.

Methods: A Markov Chain Monte Carlo probabilistic model was developed to evaluate the outcomes and costs of 1,000 simulated patients undergoing ABR vs. open Latarjet. A 20-year old male presenting with a first-time shoulder dislocation with < 10% glenoid bone-loss serves as the base case for our model. Health utility values, transition probabilities, and costs were derived from the literature. Outcome measures included costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio. Ten-year costs for each patient in the microsimulation model were averaged by initial treatment strategy to capture costs of any subsequent treatments patients underwent. Cycle length was defined as one year, with all costs and utilities discounted at 3% annually.

Results: Over the ten-year time horizon, mean total costs resulting from ABR and open Latarjet were $35,463 ± 6,377 and $32,593 ± 5,742, respectively. On average, ABR was associated with 6.8 ± 0.5 QALYs, while open Latarjet was associated with 7.9 ± 0.5 QALYs. Overall, open Latarjet was determined the preferred cost-effective strategy in 99.9% of patients included in the microsimulation model, with ABR predicted to be preferred in 0.1% of patients. Deterministic sensitivity analysis found that the recurrence risk associated with ABR would need to be less than 4.3% in order for ABR to be more cost-effective than the Latarjet procedure.

Conclusion: The open Latarjet was shown to be the dominant, cost-effective treatment strategy for first-time shoulder dislocations based on the Monte Carlo microsimulation and probabilistic sensitivity analysis. Historical data reporting higher risks of redislocation following ABR created increased downstream costs in the model that exceeded that of open Latarjet. due to the increased downstream costs incurred by recurrent dislocations. .

Level of evidence: Level III, economic and decision analysis.