Purpose
This study was conducted to investigate whether the use of resorbable bioinductive
collagen implant (RBI) in addition to conventional rotator cuff repair (conventional
RCR) is cost-effective when compared to conventional RCR alone, in the treatment of
full-thickness rotator cuff tears (FT RCT).
Methods
We developed a decision analytic model to compare the expected incremental cost and
clinical consequences for a cohort of patients with FT RCT. The probabilities for
healing or failure to heal (retear) were estimated from the published literature.
Implant and healthcare costs were estimated from a payor’s perspective in 2021 U.S.
prices. An additional analysis included indirect cost estimations (e.g., productivity
losses). Sensitivity analyses explored the effect of tear size, as well as the impact
of risk factors.
Results
The base case analysis demonstrated that resorbable bioinductive collagen implant +
conventional rotator cuff repair results in incremental costs of $232,468 and an additional
18 healed RCTs per 100 treated patients over 1 year. The estimated incremental cost-effectiveness
ratio (ICER) is $13,061/healed RCT compared to conventional RCR alone. When return
to work was included in the model, RBI + conventional RCR was found to be cost saving.
Cost-effectiveness improved with tear size with the largest benefit seen in massive
tears compared to large tears, as well as patients at higher risk of retearing.
Conclusions
This economic analysis demonstrated that RBI + conventional RCR delivered improved
healing rates at a marginal increase in costs when compared to conventional RCR alone
and is, therefore, cost-effective in this patient population. Considering indirect
costs, RBI + conventional RCR resulted in lower costs compared to conventional RCR
alone and is, therefore, deemed to be cost saving.
Level of Evidence
Level IV, economic analysis.
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References
- Clinical outcomes of conservative treatment and arthroscopic repair of rotator cuff tears: A retrospective observational study.Ann Rehabil Med. 2016; 40: 252-262
- Clinical effectiveness and cost-effectiveness of open and arthroscopic rotator cuff repair randomised trial.Health Technol Assess. 2015; 19: 1-218
- Utilization and costs of postoperative physical therapy after rotator cuff repair: A comparison of privately insured and Medicare patients.Arthroscopy. 2015; 31: 2392-2399.e1
- Separate double-layer repair versus en masse repair for delaminated rotator cuff tears: A systematic review and meta-analysis.J Orthop Surg Res. 2020; 15: 171
- Costs, complications, and reoperations associated with primary arthroscopic rotator cuff repair with or without acromioplasty and/or biceps tenodesis.Arthrosc Sports Med Rehabil. 2020; 2: e369-e376
- Epidemiology and demographics of the rotator cuff tear.in: Rotator cuff tear. Springer, New York2017
- Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: From mass-screening in one village.J Orthop. 2013; 10: 8-12
- A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age.J Shoulder Elbow Surg. 2014; 23: 1913-1921
- The societal and economic value of rotator cuff repair.J Bone Joint Surg Am. 2013; 95: 1993-2000
- Direct and indirect economic burden associated with rotator cuff tears and repairs in the US.Curr Med Res Opin. 2021; 37: 1199-1211
- Full-thickness rotator cuff tears can be safely treated with a resorbable bioinductive bovine collagen implant: One-year results of a prospective, multicenter registry.Arthrosc Sports Med Rehabil. 2021; 3: e1473-e1479
- Current concepts in rotator cuff repair techniques: Biomechanical, functional, and structural outcomes.Orthop J Sports Med. 2019; 72325967119868674
- Patient-reported outcomes after use of a bioabsorbable collagen implant to treat partial and full thickness rotator cuff tears.Arthroscopy. 2019; 35: 2262-2271
- Rotator cuff repair healing influenced by platelet-rich plasma construct augmentation.Arthroscopy. 2011; 27: 1029-1035
- Evidence of healing of partial-thickness rotator cuff tears following arthroscopic augmentation with a collagen implant: A 2-year MRI follow-up.Muscles Ligaments Tendons J. 2016; 6: 16-25
- Radiologic and clinical evaluation of a bioabsorbable collagen implant to treat partial-thickness tears: A prospective multicenter study.J Shoulder Elbow Surg. 2018; 27: 242-251
- Clinical and structural outcomes after arthroscopic single-row versus double-row rotator cuff repair: a systematic review and meta-analysis of level I randomized clinical trials.J Shoulder Elbow Surg. 2014; 23: 586-597
- Arthroscopic single-row versus double-row rotator cuff repair: A meta-analysis of the randomized clinical trials.Arthroscopy. 2013; 29: 343-348
- Do functional outcomes and cuff integrity correlate after single- versus double-row rotator cuff repair? A systematic review and meta-analysis study.Eur J Orthop Surg Traumatol. 2018; 28: 593-605
- Meta-analysis comparing single-row and double-row repair techniques in the arthroscopic treatment of rotator cuff tears.J Shoulder Elbow Surg. 2014; 23: 182-188
- Retear rates after arthroscopic single-row, double-row, and suture bridge rotator cuff repair at a minimum of 1 year of imaging follow-up: A systematic review.Arthroscopy. 2015; 31: 2274-2281
- Retear rates and clinical outcomes at 1 year after repair of full-thickness rotator cuff tears augmented with a bioinductive collagen implant: A prospective multicenter study.JSES Int. 2021; 5: 228-237
- Increasing age and tear size reduce rotator cuff repair healing rate at 1 year data from a large randomized controlled trial.Acta Orthop. 2017; 88: 606-611
- Evaluation of healing rates and safety with a bioinductive collagen patch for large and massive rotator cuff tears: 2-year safety and clinical outcomes.Am J Sports Med. 2019; 47: 1901-1908
- A systematic review of cost-effective treatment of postoperative rotator cuff repairs.J Shoulder Elbow Surg. 2017; 26: 915-922
- A survey of expert opinion regarding rotator cuff repair.JBJS. 2014; 96: e123
- Return to work after primary rotator cuff repair: A systematic review and meta-analysis.Am J Sports Med. 2021; 49: 2238-2247
- Median weekly earnings 2021.(Available at:)
- Ten arguments for a societal perspective in the economic evaluation of medical innovations.Eur J Health Econ. 2009; 10: 357-359
- Societal perspective in economic evaluation.Int J Public Heal Clin Sci. 2017; : 41-50
- Striving for a societal perspective: A framework for economic evaluations when costs and effects fall on multiple sectors and decision makers.Appl Health Econ Health Policy. 2019; 17: 577-590
- Rotator cuff repair: An analysis of utility scores and cost-effectiveness.J Shoulder Elbow Surg. 2007; 16: 181-187
- Department of Labor: Business Case for Safety.(2021. Available at)https://www.osha.gov/businesscaseDate accessed: March 21, 2022
- Effect of adding a bioinductive implant to a rotator cuff repair. Preliminary results of a randomized clinical trial.Presented at the European Society for Surgery of the Shoulder and Elbow (SECEC) Annual Congress. Dublin. September 7-9, 2022;
Article info
Publication history
Published online: February 11, 2023
Accepted:
January 4,
2023
Received:
June 12,
2022
Footnotes
The authors report the following potential conflicts of interest or sources of funding: L.F.M. reports personal fees from Smith & Nephew and Sanofi and stock options from Embody, outside the submitted work. T.F.S. reports educations grants from Arthrex and Smith & Nephew; stocks options from Kaleo, Privet, Avenue, Nash, CU Healthcare Educational Fund. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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