title: The societal and economic value of rotator cuff repair.
abstract: BACKGROUND
  Although rotator cuff disease is a common musculoskeletal problem in the United States, the impact of this condition on earnings, missed workdays, and disability payments is largely unknown. This study examines the value of surgical treatment for full-thickness rotator cuff tears from a societal perspective.
  
  
  METHODS
  A Markov decision model was constructed to estimate lifetime direct and indirect costs associated with surgical and continued nonoperative treatment for symptomatic full-thickness rotator cuff tears. All patients were assumed to have been unresponsive to one six-week trial of nonoperative treatment prior to entering the model. Model assumptions were obtained from the literature and data analysis. We obtained estimates of indirect costs using national survey data and patient-reported outcomes. Four indirect costs were modeled: probability of employment, household income, missed workdays, and disability payments. Direct cost estimates were based on average Medicare reimbursements with adjustments to an all-payer population. Effectiveness was expressed in quality-adjusted life years (QALYs).
  
  
  RESULTS
  The age-weighted mean total societal savings from rotator cuff repair compared with nonoperative treatment was $13,771 over a patient's lifetime. Savings ranged from $77,662 for patients who are thirty to thirty-nine years old to a net cost to society of $11,997 for those who are seventy to seventy-nine years old. In addition, surgical treatment results in an average improvement of 0.62 QALY. Societal savings were highly sensitive to age, with savings being positive at the age of sixty-one years and younger. The estimated lifetime societal savings of the approximately 250,000 rotator cuff repairs performed in the U.S. each year was $3.44 billion.
  
  
  CONCLUSIONS
  Rotator cuff repair for full-thickness tears produces net societal cost savings for patients under the age of sixty-one years and greater QALYs for all patients. Rotator cuff repair is cost-effective for all populations. The results of this study should not be interpreted as suggesting that all rotator cuff tears require surgery. Rather, the results show that rotator cuff repair has an important role in minimizing the societal burden of rotator cuff disease.
authors.affiliation: Duke Orthopaedic Surgery, 4709 Creekstone Drive, Suite 200, Durham, NC 27710.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Mather
authors.forename: Lane
authors.initials: L
authors.lastname: Koenig
authors.forename: Daniel
authors.initials: D
authors.lastname: Acevedo
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Dall
authors.forename: Paul
authors.initials: P
authors.lastname: Gallo
authors.forename: Anthony
authors.initials: A
authors.lastname: Romeo
authors.forename: John
authors.initials: J
authors.lastname: Tongue
authors.forename: Gerald
authors.initials: G
authors.lastname: Williams
mesh_terms: D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D006801:Humans; D008390:Markov Chains; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D013708:Tendon Injuries / Q000191:economics / Q000628:therapy*