Rotator cuff repair: An analysis of utility scores and cost-effectiveness

Mark A. Vitale, Michael G. Vitale, Joshua G. Zivin, Jonathan P. Braman, Louis U. Bigliani, Evan L. Flatow

Research output: Contribution to journalArticlepeer-review

193 Scopus citations

Abstract

More than 75,000 rotator cuff repairs are performed annually, yet cost-effectiveness data are unavailable. This study examines the cost utility of rotator cuff repair by relating surgical costs to increase in quality-adjusted life-years (QALYs). Eighty-seven patients were followed up prospectively for 1 year, during which cost and quality of life data were collected. Patient-based utility measures of quality of life (European Quality-of-Life measure [EuroQoL] and Health Utility Index [HUI]) were administered. Changes in these measures generated net QALYs. Finally, life expectancies were applied to generate a cost-effectiveness ratio, and subsequent 1-way sensitivity analyses varied costs, QALYs, and discount rates to determine which factors drive cost-effectiveness. Total costs averaged $10,605.20. Significant improvements were noted in health-related quality of life postoperatively. The estimated mean lifetime gain in QALYs from surgery was 0.81 by use of the HUI and 3.43 by use of the EuroQoL. This yielded cost-effectiveness ratios of $13,092.84/QALY by use of the HUI and $3,091.90/QALY by use of the EuroQoL. The cost-effectiveness of rotator cuff repair compares favorably with other common interventions in health care and reaches commonly accepted benchmarks for cost-effectiveness.

Original languageEnglish (US)
Pages (from-to)181-187
Number of pages7
JournalJournal of Shoulder and Elbow Surgery
Volume16
Issue number2
DOIs
StatePublished - Mar 2007

Bibliographical note

Funding Information:
This study was conducted at the Department of Orthopaedic Surgery, Columbia University, and International Center for Health Outcomes and Innovation Research, New York, NY. Supported by a grant from the Orthopaedic Research and Education Foundation, Rosemont, IL.

Funding Information:
This study was part of a prospective investigation of rotator cuff repair outcomes funded by a Prospective Clinical Research Grant from the Orthopaedic Research and Education Foundation (Rosemont, IL) (principal investigator, E.L.F.). Patients with rotator cuff tears who underwent repair by the principal investigator were eligible for the study. Inclusion required (1) rotator cuff tear verified on arthroscopic evaluation, (2) 12 or more months of failed nonsurgical treatment (steroid injection, nonsteroidal anti-inflammatory drugs, physical therapy), (3) age between 40 and 80 years, and (4) ability to communicate effectively with the investigators and be legally competent to give written informed consent. Exclusion criteria included (1) concurrent humeral arthroplasty and (2) primary glenohumeral osteoarthritis, rheumatoid arthritis, fracture, or osteonecrosis. Demographic data were collected, and costs and outcomes were directly measured for 1 year postoperatively. Institutional review board approval was obtained from the host institution, and all subjects gave informed consent.

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