Cost-effectiveness and satisfaction following arthroscopic rotator cuff repair

Abstract

Aims The aim of this study was to investigate the influence of age on the cost-effectiveness of arthroscopic rotator cuff repair. Patients and Methods A total of 112 patients were prospectively monitored for two years after arthroscopic rotator cuff repair using the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), the Oxford Shoulder Score (OSS), and the EuroQol five-dimension questionnaire (EQ-5D). Complications and use of healthcare resources were recorded. The incremental cost-effectiveness ratio (ICER) was used to express the cost per quality-adjusted life-year (QALY). Propensity score-matching was used to compare those aged below and above 65 years of age. Satisfaction was determined using the Net Promoter Score (NPS). Linear regression was used to identify variables that influenced the outcome at two years postoperatively. Results A total of 92 patients (82.1%) completed the follow-up. Their mean age was 59.5 years (sd 9.7, 41 to 78). There were significant improvements in the mean DASH (preoperative 47.6 vs one-year 15.3; p < 0.001) and OSS scores (26.5 vs 40.5; p < 0.001). Functional improvements were maintained with no significant change between one and two years postoperatively. The mean preoperative EQ-5D was 0.54 increasing to 0.81 at one year (p < 0.001) and maintained at 0.86, two years postoperatively. There was no significant difference between those aged below or above 65 years of age with regards to postoperative shoulder function or EQ-5D gains. Smoking was the only characteristic that significantly adversely influenced the EQ-5D at two years postoperatively (p = 0.005). A total of 87 were promoters and five were passive, giving a mean NPS of 95 (87/92). The total mean cost per patient was £3646.94 and the mean EQ-5D difference at one year was 0.2691, giving a mean ICER of £13 552.36/QALY. At two years, this decreased further to £5694.78/QALY. This was comparable for those aged below or above 65 years of age (£5209.91 vs £5525.67). Smokers had an ICER that was four times more expensive. Conclusion Arthroscopic rotator cuff repair results in excellent patient satisfaction and cost-effectiveness, regardless of age. Cite this article: Bone Joint J 2019;101-B:860–866.

Bilateral single-staged arthroscopic rotator cuff repair is comparable to staged procedures: a retrospective follow up study of 2 years

“…In clinical practice, although patients undergoing single-stage repair needed help with shoulder pad replacement and passive exercise, and some patients slept uncomfortably throughout the night in the early postoperative period, they could adapt and overcome difficulties gradually. We considered that letting patients know the advantages and disadvantages of different surgical options by preoperative conversation was important [31]. Patients in single-stage group have been prepared mentally for difficult postoperative rehabilitation, and one-time recovery was their expectation.…”

Development and Validation of a Simplified Chinese Version and a Face-Scale Version of the Oxford Shoulder Score: A 2-Center Prospective Study

“…The average FS-OSS score was 24.23 ± 9.11 initially and 24.04 ± 8.75 in the retest taken 5 to 7 days later, with the median (interquartile range) being 24 (18-32) and 24 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). The average initial SC-OSS was 25.56 ± 9.98, and it was 24.78 ± 9.51 during retesting, with the median (interquartile range) values of 25 (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) and 24 (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)…”

“…25 The Oxford Shoulder Score (OSS) is an internationally recognized assessment instrument to assess the pain perception and quality of life in patients with shoulder pain and to evaluate the effectiveness of different treatments. 23,24 After its original English version was published in 1996, 6 it has been translated into many languages in different cultural settings to communicate internationally. 2,3,[8][9][10][11][12]17,21,22,[29][30][31][32] In 2015, a simplified Chinese version of OSS (SC-OSS) was developed by Xu et al 39 Even so, high illiteracy and low income in the developing countries may limit the applicability of the OSS.…”

Shoulder conditions and health related quality of life and utility: a current concepts review

“…Nicholson et al 43 used the EQ-5D in a prospective study to determine the value of RCR in patients with massive RCTs. They found that arthroscopic RCR led to a mean improvement in the EQ-5D from 0.54 at baseline to 0.81 at one year ( P < .001) and 0.86 at two years ( P = .08).…”