Bio-Inductive Collagen Implant Augmentation for Arthroscopic Rotator Cuff Repair Is Cost-Effective in Medium to Large Tears for Reducing Retears: A Secondary Analysis of a Randomized Controlled Trial.

Abstract

To perform a Markov model-based cost-effectiveness analysis comparing arthroscopic rotator cuff repair (ARCR) and bio-inductive collagen implant (BCI) to ARCR for symptomatic, medium-to-large rotator cuff tears. A Markov chain Monte Carlo probabilistic model was developed to evaluate the outcomes and costs of 1000 simulated patients undergoing ARCR + BCI versus ARCR for isolated, symptomatic, reparable, full-thickness, medium-to-large posterosuperior nonacute rotator cuff tears, with fatty infiltration ≤2. Health utility values, transition probabilities, and costs were derived from the published literature. Outcome measures included costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER). Ten-year costs for each patient in the microsimulation model were averaged by initial treatment strategy to capture costs of any subsequent treatments patients underwent as a result of retears. Cycle length was defined as 1 year, with all costs and utilities discounted at 3% annually. Disutility was applied to patient health states involving conversion to reverse shoulder arthroplasty (RSA) for retears and postoperative complications. Over the 10-year time horizon, mean total costs resulting from ARCR + BCI and ARCR were $49,240 ± $8516 and $56,358 ± $8665, respectively. On average, ARCR + BCI was associated with 5.6 ± 0.4 QALYs, while ARCR alone was associated with 4.3 ± 0.4 QALYs. Overall, ARCR + BCI was determined the preferred cost-effective strategy in 100% of patients included in the microsimulation model. Deterministic sensitivity analysis on the risk of retear associated with ARCR + BCI found that the recurrence risk associated with ARCR + BCI would need to be greater than 26.5% in order for ARCR without BCI augmentation to be more cost-effective than ARCR + BCI at a willingness-to-pay threshold of $50,000/QALY. ARCR + BCI was determined to be the dominant, cost-effective treatment strategy to reduce retears for symptomatic, medium-to-large rotator cuff tears based on the Monte Carlo microsimulation and probabilistic sensitivity analysis. Patients treated ARCR alone faced higher retear rates, leading to greater downstream costs that ultimately exceeded those of the ARCR + BCI group. Level I, economic and decision analysis.