对于不可修复的肩袖撕裂，哪种治疗策略最具成本效益？基于马尔可夫模型的成本-效用分析比较上囊重建、下斜方肌腱转移、肩峰下球囊垫片植入和反向肩关节置换术

IF 2.7 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2025-02-13 DOI:10.1002/jeo2.70180

Jacob F. Oeding, Kyle N. Kunze, Ayoosh Pareek, Kristian Samuelsson

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引用次数: 0

摘要

不可修复的肩袖撕裂（irct）的治疗方案仍有争议，包括上囊重建（SCR）、下斜方肌腱转移（LTTT）、肩峰下球囊间隔（SABS）和反向肩关节置换术（RSA）。尽管有报道称所有方法都有积极的治疗反应，但在相关成本背景下的相对临床效益尚未得到很好的描述。本研究的目的是确定SCR、ltt、SABS和RSA对大量irct患者最具成本效益的治疗策略。方法建立马尔可夫链蒙特卡罗概率模型，评估1000例模拟患者接受SCR、LTTT、SABS或RSA进行大规模irct的结果和成本。前期成本、健康效用值和再手术率（包括修订和转换为RSA）均来自已发表的文献。结果测量包括成本、质量调整生命年（QALYs）和增量成本-效果比（ICER）。结果SCR、RSA、ltt和SABS的平均总成本分别为30540±5770美元、26896±5622美元、25819±4325美元和16412±2583美元。SCR、RSA、ttt和SABS的总质量ys平均值分别为6.17±0.53、3.78±0.38、5.33±0.49和5.59±0.48。总体而言，在微观模拟模型中，60%的患者认为SCR是首选的、最具成本效益的策略，31%的患者认为SABS是最佳策略，9%的患者认为ltt是最佳策略。结论基于目前的微观模拟和概率敏感性分析，SCR被认为是irct最具成本效益的治疗方案，尽管LTTT和SABS在特定患者中也被发现具有成本效益。鉴于该统计模型没有考虑个体患者的独特经历，共同决策仍然是确定irct最佳治疗策略的重要组成部分。证据水平III级，经济决策模型。

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Which treatment strategy for irreparable rotator cuff tears is most cost-effective? A Markov model-based cost-utility analysis comparing superior capsular reconstruction, lower trapezius tendon transfer, subacromial balloon spacer implantation and reverse shoulder arthroplasty

Purpose

Treatment options for irreparable rotator cuff tears (IRCTs) remain controversial and include superior capsular reconstruction (SCR), lower trapezius tendon transfer (LTTT), subacromial balloon spacer (SABS), and reverse shoulder arthroplasty (RSA). Despite reports of positive treatment responses with all approaches, the relative clinical benefit in the context of associated cost has not been well delineated. The purpose of this study was to determine the most cost-effective treatment strategy among SCR, LTTT, SABS, and RSA for patients with massive IRCTs.

Methods

A Markov Chain Monte Carlo probabilistic model was developed to evaluate the outcomes and costs of 1000 simulated patients undergoing either SCR, LTTT, SABS, or RSA for massive IRCTs. Upfront costs, health utility values, and reoperation rates including revisions and conversion to RSA were derived from the published literature. Outcome measures included costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER).

Results

Mean total costs of SCR, RSA, LTTT, and SABS were $30,540 ± 5,770, $26,896 ± 5,622, $25,819 ± 4,325, and $16,412 ± 2,583, respectively. On average, total QALYs from SCR, RSA, LTTT, and SABS were 6.17 ± 0.53, 3.78 ± 0.38, 5.33 ± 0.49, and 5.59 ± 0.48. Overall, SCR was determined the preferred, most cost-effective strategy in 60% of patients included in the microsimulation model, with SABS the optimal strategy in 31% of cases and LTTT the optimal strategy in 9% of cases.

Conclusion

SCR was found to be the most cost-effective treatment option for IRCTs based on the current microsimulation and probabilistic sensitivity analyses, although LTTT and SABS were also found to be cost-effective in select patients. Given that this statistical model does not consider the unique experiences of individual patients, shared decision-making remains an important component in determining the optimal treatment strategy for IRCTs.