Cost-effectiveness of open versus arthroscopic rotator cuff repair

Background: Economic evaluation of surgical procedures is necessary in view of more expensive newer techniques emerging in an increasingly cost-conscious health care environment. This study compares the cost-effectiveness of open rotator cuff repair with arthroscopic repair for moderately size tears. Materials and methods: This was a prospective study of 30 consecutive patients, of whom 15 had an arthroscopic repair and 15 had an open procedure. Clinical effectiveness was assessed using Oxford and Constant shoulder scores. Costs were estimated from departmental and hospital financial data. Results: At last follow-up, no difference Oxford and Constant shoulder scores was noted between the 2 methods of repair. There was no significant difference between the groups in the cost of time in the operating theater, inpatient time, amount of postoperative analgesia, number of postoperative outpatient visits, physiotherapy costs, and time off work. The incremental cost of each arthroscopic rotator cuff repair was 675 pound ($1248.75) more than the open procedure. This was mainly in the area of direct health care costs, instrumentation in particular. Discussion: Health care policy makers are increasingly demanding evidence of cost-effectiveness of a procedure. This study showed both methods of repair provide equivalent clinical results. Conclusion: Open cuff repair is more cost-effective than arthroscopic repair and is likely to have lower cost-utility ratio. In addition, the tariff for the arthroscopic procedure in some health care systems is same as open repair. Level of evidence: Level II, Economic Analysis Study. (C) 2010 Journal of Shoulder and Elbow Surgery Board of Trustees.