title: Revision Arthroscopic Repair Versus Latarjet Procedure in Patients With Recurrent Instability After Initial Repair Attempt: A Cost-Effectiveness Model.
abstract: To compare the cost-effectiveness of arthroscopic revision instability repair and Latarjet procedure in treating patients with recurrent instability after initial arthroscopic instability repair.
  
  
  
  An expected-value decision analysis of revision arthroscopic instability repair compared with Latarjet procedure for recurrent instability followed by failed repair attempt was modeled. Inputs regarding procedure cost, clinical outcomes, and health utilities were derived from the literature.
  
  
  
  Compared with revision arthroscopic repair, Latarjet was less expensive ($13,672 v $15,287) with improved clinical outcomes (43.78 v 36.76 quality-adjusted life-years). Both arthroscopic repair and Latarjet were cost-effective compared with nonoperative treatment (incremental cost-effectiveness ratios of 3,082 and 1,141, respectively). Results from sensitivity analyses indicate that under scenarios of high rates of stability postoperatively, along with improved clinical outcome scores, revision arthroscopic repair becomes increasingly cost-effective.
  
  
  
  Latarjet procedure for failed instability repair is a cost-effective treatment option, with lower costs and improved clinical outcomes compared with revision arthroscopic instability repair. However, surgeons must still incorporate clinical judgment into treatment algorithm formation.
  
  
  
  Level IV, expected value decision analysis.
authors.affiliation: Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A.. Electronic address: ericmakhnimd@gmail.com.
authors.forename: Eric C
authors.initials: EC
authors.lastname: Makhni
authors.affiliation: Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Nayan
authors.initials: N
authors.lastname: Lamba
authors.affiliation: Department of Orthopedic Trauma, Carolinas Medical Center, Charlotte, North Carolina, U.S.A.
authors.forename: Eric
authors.initials: E
authors.lastname: Swart
authors.affiliation: Department of Orthopedic Surgery, Hospital for Special Surgery, New York City, New York, U.S.A.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Steinhaus
authors.affiliation: Department of Orthopedic Surgery, Columbia University Medical Center, New York City, New York, U.S.A.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Ahmad
authors.affiliation: Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Romeo
authors.affiliation: Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A.
authors.forename: Nikhil N
authors.initials: NN
authors.lastname: Verma
mesh_terms: D001182:Arthroscopy / Q000191:economics* / Q000379:methods*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation / Q000191:economics*; D012785:Shoulder Joint / Q000601:surgery*; D014481:United States