Arthroscopic bankart repair surgery is a costeffective alternative approach for patients suffering their first anterior shoulder dislocation, according to research presented by Ryan Patrick Donegan, MD, from Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, and colleagues based on using currently available probabilities, estimated costs, and prospectively collected health state utilities.
“We based our conclusions on a Markov model, which takes into account how surgery affects the patient’s recovery in relation to the actual costs of medical treatment,” commented Donegan. The incremental cost-effectiveness ratio (ICER) for arthroscopic bankart versus nonoperative treatment was approximately $43,500. “For surgery to be costeffective in this model, expenses must be under $24,457, the probability of re-dislocation must be under 7%, and the quality of life rating must not fall below 0.86,” Donegan noted. “Our research showed surgical costs of $11,267, probability of re-dislocation at only 4% and quality of life rating of 0.93—numbers suggesting surgery is a good investment for these patients,” continued Donegan. Therefore, the estimated cost of surgical treatment must increase from approximately $11,000 to $24,000 for surgery to no longer be cost-effective. The probability of nonoperative treatment must decrease from 17% to approximately 11% for surgery to also no longer be cost-effective.
Researchers drew data from literature reporting on first-time shoulder-repair arthroscopies in patients from 15 to 35 years old. They also gathered information from a 50-patient survey using a time trade-off method approved by the Dartmouth-Hitchcock Medical Center’s Institutional Review Board. The probabilities of the various treatment outcomes and the costs
associated with treatment were derived from the orthopaedic literature and adjusted Medicare reimbursement rates.
“Shoulder dislocations are one of the most common orthopaedic issues today, and our research shows that–after weighing all the options–surgery can be both helpful to the recovery process and cost-effective,” Donegan shared.
Donegan and colleagues note that nonoperative treatment based on rest and physical therapy should still be considered an effective treatment option for patients. There is still room for further studies to focus on identifying patient populations that fall within the threshold values identified in the analysis.