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...

Overview

Journal J Exp Orthop

Publisher Wiley

Specialty Orthopedics

Date 2025 Feb 14

PMID 39949712

Authors

Jacob F Oeding

Kyle N Kunze

Ayoosh Pareek

Kristian Samuelsson

Affiliations

Soon will be listed here.

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.

Citing Articles

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....

Oeding J, Kunze K, Pareek A, Samuelsson K J Exp Orthop. 2025; 12(1):e70180.

PMID: 39949712 PMC: 11822265. DOI: 10.1002/jeo2.70180.

References

Beck J, Pauker S . The Markov process in medical prognosis. Med Decis Making. 1983; 3(4):419-458. DOI: 10.1177/0272989X8300300403. View

Castagna A, Garofalo R, Maman E, Gray A, Brooks E . Comparative cost-effectiveness analysis of the subacromial spacer for irreparable and massive rotator cuff tears. Int Orthop. 2018; 43(2):395-403. PMC: 6399196. DOI: 10.1007/s00264-018-4065-x. View

Mercurio M, Castricini R, Castioni D, Cofano E, Familiari F, Gasparini G . Better functional outcomes and a lower infection rate can be expected after superior capsular reconstruction in comparison with latissimus dorsi tendon transfer for massive, irreparable posterosuperior rotator cuff tears: a systematic review. J Shoulder Elbow Surg. 2022; 32(4):892-906. DOI: 10.1016/j.jse.2022.11.004. View

Oh J, Park M, Rhee S . Treatment Strategy for Irreparable Rotator Cuff Tears. Clin Orthop Surg. 2018; 10(2):119-134. PMC: 5964259. DOI: 10.4055/cios.2018.10.2.119. View

de Marinis R, Marigi E, Atwan Y, Velasquez Garcia A, Morrey M, Sanchez-Sotelo J . Lower Trapezius Transfer Improves Clinical Outcomes With a Rate of Complications and Reoperations Comparable to Other Surgical Alternatives in Patients with Functionally Irreparable Rotator Cuff Tears: A Systematic Review. Arthroscopy. 2023; 40(3):950-959. DOI: 10.1016/j.arthro.2023.06.029. View

Mather 3rd R, Garrett W, Cole B, Hussey K, Bolognesi M, Lassiter T . Cost-effectiveness analysis of the diagnosis of meniscus tears. Am J Sports Med. 2014; 43(1):128-37. DOI: 10.1177/0363546514557937. View

Davies A, Singh P, Reilly P, Sabharwal S, Malhas A . Superior capsule reconstruction, partial cuff repair, graft interposition, arthroscopic debridement or balloon spacers for large and massive irreparable rotator cuff tears: a systematic review and meta-analysis. J Orthop Surg Res. 2022; 17(1):552. PMC: 9764484. DOI: 10.1186/s13018-022-03411-y. View

Luthringer T, Fares M, Rondon A, Vaughan A, Khan A, Abboud J . Subacromial Balloon Spacer Versus Partial Rotator Cuff Repair in the Treatment of Massive Irreparable Rotator Cuff Tears: Facility Personnel Allocation and Procedural Cost Analysis. Cureus. 2023; 15(7):e41538. PMC: 10404648. DOI: 10.7759/cureus.41538. View

Briggs A . Statistical approaches to handling uncertainty in health economic evaluation. Eur J Gastroenterol Hepatol. 2004; 16(6):551-61. DOI: 10.1097/00042737-200406000-00007. View

10.

Neumann P, Cohen J, Weinstein M . Updating cost-effectiveness--the curious resilience of the $50,000-per-QALY threshold. N Engl J Med. 2014; 371(9):796-7. DOI: 10.1056/NEJMp1405158. View

11.

Kovacevic D, Suriani Jr R, Grawe B, Yian E, Gilotra M, Hasan S . Management of irreparable massive rotator cuff tears: a systematic review and meta-analysis of patient-reported outcomes, reoperation rates, and treatment response. J Shoulder Elbow Surg. 2020; 29(12):2459-2475. PMC: 7669555. DOI: 10.1016/j.jse.2020.07.030. View

12.

Dodd S, Bassi A, Bodger K, Williamson P . A comparison of multivariable regression models to analyse cost data. J Eval Clin Pract. 2006; 12(1):76-86. DOI: 10.1111/j.1365-2753.2006.00610.x. View

13.

Vermue H, Tack P, Gryson T, Victor J . Can robot-assisted total knee arthroplasty be a cost-effective procedure? A Markov decision analysis. Knee. 2021; 29:345-352. DOI: 10.1016/j.knee.2021.02.004. View

14.

Levy K, White C, Pujari A, Patel A, Kator J, Parsons B . Subacromial Balloon Spacer Implantation Is a Promising Alternative for Patients With Massive Irreparable Rotator Cuff Tears: A Systematic Review. Arthroscopy. 2023; 40(1):162-173.e2. DOI: 10.1016/j.arthro.2023.05.028. View

15.

Dasari S, Khan Z, Swindell H, Mehta N, Kerzner B, Verma N . Subacromial Balloon Spacer: Indications, Rationale, and Technique. JBJS Essent Surg Tech. 2023; 12(2):e21.00069. PMC: 9889290. DOI: 10.2106/JBJS.ST.21.00069. View

16.

Marigi E, Johnson Q, Dholakia R, Borah B, Sanchez-Sotelo J, Sperling J . Cost comparison and complication profiles of superior capsular reconstruction, lower trapezius transfer, and reverse shoulder arthroplasty for irreparable rotator cuff tears. J Shoulder Elbow Surg. 2021; 31(4):847-854. DOI: 10.1016/j.jse.2021.08.027. View

17.

Doubilet P, Begg C, Weinstein M, Braun P, McNeil B . Probabilistic sensitivity analysis using Monte Carlo simulation. A practical approach. Med Decis Making. 1985; 5(2):157-77. DOI: 10.1177/0272989X8500500205. View

18.

Sanders G, Neumann P, Basu A, Brock D, Feeny D, Krahn M . Recommendations for Conduct, Methodological Practices, and Reporting of Cost-effectiveness Analyses: Second Panel on Cost-Effectiveness in Health and Medicine. JAMA. 2016; 316(10):1093-103. DOI: 10.1001/jama.2016.12195. View

19.

Berk A, Cregar W, Gachigi K, Trofa D, Schiffern S, Hamid N . Outcomes of subacromial balloon spacer implantation for irreparable rotator cuff tears: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2023; 32(10):2180-2191. DOI: 10.1016/j.jse.2023.04.016. View

20.

Cohen D, Reynolds M . Interpreting the results of cost-effectiveness studies. J Am Coll Cardiol. 2008; 52(25):2119-26. PMC: 2716087. DOI: 10.1016/j.jacc.2008.09.018. View