Cost-effectiveness of rotator cuff repair based on modern constructs, tear size, and implant cost at 1, 5, and 10 years

Abstract

Background

To evaluate the cost-effectiveness of arthroscopic rotator cuff repair (RCR) utilizing multiple surgical constructs sorted by tear size.

Methods

Real-world cost data and previously published data on both anchor failure loads and retear rates by tear size and construct were inputted into a Markov model with time-points of 1, five, and ten years. Cost-effectiveness was assessed in terms of cost per quality-adjusted life-year (QALY). Health states included intact repair, asymptomatic or symptomatic retear, revision RCR, and cuff tear arthropathy. Knotted and knotless single row (SR) and double row (DR) constructs were used.

Results

For small and medium-sized tears, the optimal 10-year strategy was the DR knotted Corkscrew Biocomposite/Swivelock Biocomposite, which had an incremental cost-effectiveness ratio (ICER) of $12,562/QALY and $16,678/QALY, adding 0.54 QALY and 0.51 QALY versus nonoperative management, respectively. For large tears, the optimal 10-year strategy was the DR knotless Swivelock Biocomposite, which had an ICER of $19,836/QALY and added 0.53 QALY versus nonoperative management. For massive tears, the optimal 10-year strategy was the DR knotless Healicoil PEEK/Footprint Ultra polyether ether ketone, which had an ICER of $27,748/QALY and added 0.46 QALY versus nonoperative management.

Conclusion

Our study uniquely used modern suture anchors and construct configurations including knotted and knotless for multiple commercially available systems and for every tear size to evaluate short- and long-term cost-effectiveness. We found that, compared to nonoperative management, operative management of cuff tears was the optimal long-term treatment modality; specifically, when considering massive RCT, the DR knotless construct was optimal. This was supported by our finding that operative management of cuff tears is increasingly cost-effective with time, given nonrepaired cuff tears are unlikely to heal and portend worse symptomatology. Our findings may help inform surgeons/payors and guide anchor and construct selection for optimization of value-based care when performing arthroscopic RCR.