title: The Cost-Effectiveness of Using Platelet-Rich Plasma During Rotator Cuff Repair: A Markov Model Analysis.
abstract: To perform a cost-utility analysis to determine if the use of platelet-rich plasma (PRP) products during arthroscopic rotator cuff repair (RCR) is cost-effective.
  
  
  
  A cost-utility analysis was conducted using a Markov decision model. Model inputs including health utility values, retear rates, and transition probabilities were derived from the best evidence available in the literature regarding full-thickness rotator cuff tears and their repair, as well as the augmentation of their repair with PRP. Costs were determined by examining the typical patient undergoing treatment for a full-thickness rotator cuff tear in a private orthopaedic clinic and outpatient surgery center.
  
  
  
  The cost per quality-adjusted life-year ($/QALY) of RCR with and without PRP was $6,775/QALY and $6,612/QALY, respectively. In our base case, the use of PRP to augment RCR was not cost-effective because it had exactly the same "effectiveness" as RCR without PRP augmentation while being associated with a higher cost (additional $750). Sensitivity analysis showed that to achieve a willingness-to-pay threshold of $50,000/QALY, the addition of PRP would need to be associated with a 9.1% reduction in retear rates. If the cost of PRP were increased to $1,000, the retear rate would need to be reduced by 12.1% to reach this same threshold. This compared with a necessary reduction of only 6.1% if the additional cost of PRP was $500.
  
  
  
  This cost-utility analysis shows that, currently, the use of PRP to augment RCR is not cost-effective. Sensitivity analysis showed that PRP-augmented repairs would have to show a reduced retear rate of at least 9.1% before the additional cost would be considered cost-effective.
  
  
  
  Level III, analysis of Level I, II, and III studies.
authors.affiliation: CHI Alegent Creighton Clinic, Omaha, Nebraska, U.S.A.. Electronic address: eric.samuelson@alegent.org.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Samuelson
authors.affiliation: OrthoCarolina Research Institute, Charlotte, North Carolina, U.S.A.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Odum
authors.affiliation: OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, U.S.A.
authors.forename: James E
authors.initials: JE
authors.lastname: Fleischli
mesh_terms: D001182:Arthroscopy; D003362:Cost-Benefit Analysis; D006801:Humans; D008390:Markov Chains; D053657:Platelet-Rich Plasma; D019057:Quality-Adjusted Life Years; D000070636:Rotator Cuff Injuries / Q000601:surgery*