Cost-effectiveness analysis of arthroscopic surgery versus open surgery in rotator cuff repair

Abstract

Objective: This study aimed to compare the open and arthroscopic rotator cuff tear treatment methods in terms of cost-effectiveness. Patients and Methods: TThis study includes a prospective method of a total of 104 patients, 52 with open surgery and 52 with arthroscopic surgery, in the treatment of rotator cuff tears. Cost calculations of the treatment methods were obtained from patient invoices. Oxford Shoulder Score and Short Form-36 Health Survey Questionnaire were used for effectiveness calculations. The costeffectiveness comparison was conducted using the Incremental Cost Effectiveness Ratio (ICER) assessment. The difference between costs of open and arthroscopic surgery was analyzed using the SPSS 23.0 package program. with Mann-Whitney U test. Results: The average cost per patient was 4,838.7 Turkish Liras (TL) (866.22 USD) in open surgery and 5,770.33 TL (1,033.00 USD) according to the exchange rate at the time of writing, in arthroscopic surgery. Oxford Shoulder Score was 21.15 in open surgery and 20.83 in arthroscopic surgery. Short Form-36 Health Survey Questionnaire score was 61.92 in open surgery and 63.17 in arthroscopic surgery. The ICER calculated according to the Oxford Shoulder Score was – 2,912.37 TL (521,37 USD), while the ICER calculated according to the General Health Perception sub-scale of Short Form-36 was 745.57 TL (133,47 USD). In addition, statistical significant difference was found between the surgery, medication, medical and surgical materials, hospitalization and average cost of those treated with open surgery and those treated with arthroscopic surgery (p<0.05). Conclusion: There was no statistically significant difference between the efficacy scores of the treatment groups. However, there was statistically significant difference between costs of the treatment groups.

Keywords

• Rotator cuff Injuries
• Rotator cuff Repair
• Cost-effectiveness

References

1. Karapınar S, Uruç V, Özden R, Duman İ, Doğramacı Y, Kalacı A. Clinical radiological outcomes of rotator cuff repair by single-row suture-anchor technique with mini – open approach. Dicle Med J 2014; 41: 347-51. doi: 10.5798/ diclemedj.0921.2014.02.0429
2. Mahiroğulları M, İşyar M, Çakmak S. Rotator cuff tears. TOTBID Journal 2013;12: 353 – 59. doi: 10.14292/totbid. dergisi.2013.43
3. Aminzadeh B, Najafi S, Moradi A, Abbasi B, Farrokh D, Emadzadeh M. Evaluation of diagnostic precision of ultrasound for rotator cuff disorders in patients with shoulder pain. Arch Bone Jt Surg 2020;8:689-95. doi:10.22038/ abjs.2020.42894.2166
4. Kjima H, Minagawa H, Nishi T, Kikuchi K, Shimada Y. Long-term follow-up of cases of Rotator cuff tear treated conservatively. J Shoulder Elb Surg 2012; 2: 491-94. doi:10.1016/j.jse.2011.10.012
5. Bunker T. Rotator cuff disease. Current Orthopaedics 2002; 16: 223-33. doi: 10.1054/cuor.2002.0257
6. Yaradılmış Y, Okkaoğlu M, Şeşen H, Tarğal A, Ateş A, Altay M. There is no difference in between clinical results of fast transosseos repair and double row suture anchor technique for repair of rotator cuff rupture. Bozok Med J 2019; 9 : 1-8. doi: 10.16919/bozoktip.427558
7. 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 2019; 43: 395-403. doi:10.1007/s00264.018.4065-x
8. First 100 Hospitals in Each Branch 2017 January-October Policlinic, Hospitalization, Intensive Care and Emergency Service Statistics. https://dosyahastane.saglik.gov.tr/ Eklenti/9300,2017-ocak-ekim-donemi-poliklinik-yatis- ve-yogun-bakim-ve-acil-servis-verileri-baglaminda-herbransta- ilk-100-hastanepdf.pdf?0 (Access date: 01.11.2019)

9. Vitale MA, Vitale MG, Zivin JG, Braman JP, Bigliani LU, Flatow EL. Rotator cuff repair: an analysis of utility scores and cost-effectiveness. J Shoulder Elb Surg 2007;16: 181-7. doi: 10.1016/j.jse.2006.06.013
10. Deprés-Tremblay G, Chevrier A, Snow M, Hurtig MB, Rodeo S, Buschmann MD. Rotator cuff repair: a review of surgical techniques, animal models, and new technologies under development. J Shoulder Elb Surg 2016; 25: 2078-85. doi:10.1016/j.jse.2016.06.009
11. Wylie JD, Suter, T, Potter, MQ, Granger EK, Tashjian RZ. Mental health has a stronger association with patient-reported shoulder pain and function than tear size in patients with fullthickness rotator cuff tears. J Bone Joint Surg 2016; 98:251-6. doi: 10.2106/JBJS.O.00444
12. Thangarajah T. Augmentation of rotator cuff tendon-bone healing using demineralised bone matrix and mesenchymal stem cells. 2017; (Unpublished doctoral dissertation) University College London, England.
13. Itoi E. Rotator cuff tear: physical examination and conservative treatment. J Orthop Sci 2013; 18:,197-204. doi: 10.1007/ s00776.012.0345-2
14. Weale A, Halabi M, Jones P, White S. Perceptions of outcomes after unicompartmental and total knee replacements. Clin Orthop Relat Res 2001; 382: 143-53. doi:0301-620X/97/11269
15. Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg 2004; 86:219-24.
16. Carr C. Cooper CM, Rees J, et. al. Clinical effectiveness and cost-effectivenessof open and arthroscopic rotator cuff repair the UK rotator cuff Surgery (UKUFF) randomised trial. Health Technol Assess 2015; 19: 1-218. doi:10.3310/hta19800
17. Mather R, Koenig L, Acevedo D, et al. The societal and economic value of rotator cuff repair. J Bone Joint Surg 2013; 95: 1993-2000. doi:10.2106/JBJS.L.01495
18. Barnes LF, Kim HM, Caldwell JM, et al. Satisfaction, function and repair integrity after arthroscopic versus miniopen rotator cuff repair. J Bone Joint Surg 2017; 99: 245- 9. doi: 10.1302/0301-620X.99B2.BJJ-2016-0055.R1
19. Dawson J, Hill G, Fitzpatrick R, Carr A. The benefits of using patient-based methods of assessment. Medium-term results of an observational study of shoulder surgery. J Bone Joint Surg 2001:1: 877-82. doi:0301-620X/01/611316
20. Grevitt M, Khazim R, Webb J, Mulholland R, Shepperd J. The short form-36 health survey questionnaire in spine surgery. J Bone Joint Surg [Br] 1997;79-B:48-52. doi:10.1302/0301- 620X.79B1.0790048
21. McElvany M, McGoldrick E, GA Neradilek, Frederick A. Rotator cuff repair. Int J Sports Med 2014; 43: 491-500. doi:10.1177/036.354.6514529644
22. Tuğay U, Tuğay N, Gelecek N, Özkan M. Oxford shoulder score: cross-cultural adaptation and validation of the Turkish version. Arch Orthop Trauma Surg 2011; 131: 687-94. doi:10.1007/s00402.010.1242-9
23. Olley L, Carr A. The use of a patient-based questionnaire (the Oxford Shoulder Score) to assess outcome after rotator cuff repair. Ann R Coll Surg Engl 2008; 90: 326-31. doi:10.1308/003588408X285964
24. Weale A, Halabi M, Jones P, White S. Perceptions of outcomes after unicompartmental and total knee replacements. Clin Orthop Relat Res 2001; 382: 143-53. doi:0301-620X/97/11269
25. Oxford Shoulder Score, http://www.orthopaedicscore. com/scorepages/oxford_shoulder_score.html. (access date: 12.11.2019)
26. Koçyiğit H, Aydemir Ö, Fişek G, Ölmez N, Memiş A. Validity and reliability of Turkish version of SF-36. J Drug Ther 1999; 12: 102-06.
27. Iannotti JP, Deutsch A, Green A, et al. Time to failure after rotator cuff repair: a prospective imaging study. 2013 J Bone Joint Surg 2013;95: 965-71.
28. Genuario J, Donegan R, Hamman D, et al. The costeffectivenessof single-row compared with double-row arthroscopic rotator cuff repair. J Bone Joint Surg 2012: 94: 1369-77. doi:10.2106/JBJS.J.01876
29. Hui Y, Teo A, Sharma S, Tan BHM, Kumar V. Immediate costs of mini-open versus arthroscopic rotator cuff repair in an Asian population. J Orthop Surg 2017; 25: 1-6. doi:10.1177/230.949.9016684496
30. Adla D, Rowsell M, Pandey R. Cost-effectivenessof open versus arthroscopic rotator cuff repair. J Shoulder Elbow Surg 2010; 19: 258-61. doi:10.1016/j.jse.2009.05.004
31. Narvy SJ, Ahluwalia A, Vangsness CT. Analysis of direct costs of outpatient arthroscopic rotator cuff repair. Am J Orthop (Belle Mead NJ) 2016; 45.1: E7-E11.
32. Murphy J, Gray A, Cooper C, Cooper D, Ramsay C, Carr A. Costs, quality of life and cost-effectiveness of arthroscopic and open repair for rotator cuff tears: an economic evaluation alongside the UKUFF trial. Bone Joint J 2016;98-B:1648-55. doi: 10.1302/0301-620X.98B12.BJJ-2016-0121.R1.
33. Carr A, Cooper C, Campbell, et al. Effectiveness of open and arthroscopic rotator cuff repair (UKUFF): a randomised controlled trial. J Bone and Joint Surg 2017; 99: 107-15. doi: 10.1302/0301-620X.99B1.BJJ-2016-0424.R1
34. Churchill S, Ghoria J. Total cost and operating room time comparison of rotator cuff repair techniques at low, intermediate, and high volume centers: Mini-open versus all-arthroscopic. J Shoulder Elb Surg 2010: 19: 716-21. doi:10.1016/j.jse.2009.10.011