title: Cost-Effectiveness of Arthroscopic Rotator Cuff Repair Versus Reverse Total Shoulder Arthroplasty for the Treatment of Massive Rotator Cuff Tears in Patients With Pseudoparalysis and Nonarthritic Shoulders.
abstract: OBJECTIVE
  To determine the most cost-effective treatment strategy for patients with massive rotator cuff tears and pseudoparalysis of the shoulder without osteoarthritis of the glenohumeral joint (PP without OA). Specifically, we aimed to compare arthroscopic rotator cuff repair (ARCR) versus reverse total shoulder arthroplasty (RTSA) and investigate the effect of patient age on this decision.
  
  
  METHODS
  A Markov decision model was used to compare 3 treatment strategies for addressing PP without OA: (1) ARCR with option to arthroscopically revise once, (2) ARCR with immediate conversion to RTSA on potential failure, and (3) primary RTSA. Hypothetical patients were cycled through the model according to transition probabilities, meanwhile accruing financial costs, utility for time in health states, and disutilities for surgical procedures. Utilities were derived from the Short Form-6D scale and expressed as quality-adjusted life-years. Model parameters were derived from the literature and from expert opinion, and thorough sensitivity analyses were conducted. TreeAge Pro 2015 software was used to construct and assess the Markov model.
  
  
  RESULTS
  For the base-case scenario (60-year-old patient), ARCR with conversion to RTSA on potential failure was the most cost-effective strategy when we assumed equal utility for the ARCR and RTSA health states. Primary RTSA became cost-effective when the utility of RTSA exceeded that of ARCR by 0.04 quality-adjusted life-years per year. Age at decision did not substantially change this result.
  
  
  CONCLUSIONS
  Primary ARCR with conversion to RTSA on potential failure was found to be the most cost-effective strategy for PP without OA. This result was independent of age. Primary ARCR with revision ARCR on potential failure was a less cost-effective strategy.
  
  
  METHODS
  Level IV, economic and decision analysis.
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
authors.forename: Grant J
authors.initials: GJ
authors.lastname: Dornan
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany.
authors.forename: J Christoph
authors.initials: JC
authors.lastname: Katthagen
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
authors.forename: Dimitri S
authors.initials: DS
authors.lastname: Tahal
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Petri
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Greenspoon
authors.affiliation: Southern Oregon Orthopedics, Medford, Oregon, U.S.A.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Denard
authors.affiliation: The San Antonio Orthopaedic Group, San Antonio, Texas, U.S.A.
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Burkhart
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; The Steadman Clinic, Vail, Colorado, U.S.A.. Electronic address: drmillett@thesteadmanclinic.com.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Millett
mesh_terms: D000072228:Arthroplasty, Replacement, Shoulder / Q000191:economics*; D001182:Arthroscopy / Q000191:economics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006801:Humans; D019057:Quality-Adjusted Life Years; D000070636:Rotator Cuff Injuries / Q000601:surgery*