Rotator Cuff Repair with Concomitant Biceps Tenodesis is Cost-Effective at Mid-Term Follow-up: A Systematic Review and Cost-Effective Analysis.

BACKGROUND: There is limited evidence describing the cost-effectiveness of isolated rotator cuff repair (RCR) compared to rotator cuff repair with biceps tenodesis (BT) in the treatment of primary rotator cuff tears at mid-term follow-up.

PURPOSE: (1) To perform a cost utility analysis comparing RCR to RCR with BT in patients with rotator cuff tears over a 5-year time horizon.

METHODS: A decision tree economic model was constructed to evaluate the cost-effectiveness of RCR vs RCR with BT across a 5-year time horizon. Model transition probabilities, costs, and health utility measures, based on EQ-5D (European Quality of Life-5 Dimension) scores, were derived from the literature. Health utility was measured in quality-adjusted life years (QALYs) and cost-effectiveness was based on the incremental cost-effectiveness ratio (ICER) considering a willingness to pay (WTP) threshold of $50,000/QALY. Monte Carlo probabilistic and one-way sensitivity analysis was performed to assess for parameter uncertainty. Each cycle length was defined as 1 year, and 5-year costs and utilities were calculated with 3% annual discounting.

RESULTS: Over a 5-year horizon, RCR with BT yielded 3.713 QALYs at a mean cost of $34,182 compared to 3.651 QALYs and $33,372 for RCR alone. RCR with BT was found to be cost-effective with an ICER of $13,064/QALY and a positive net monetary benefit of $2,289. RCR with BT was the preferred treatment in 88.51% of 1,000 simulations on probabilistic sensitivity analysis. One-way sensitivity analyses demonstrated cost-effectiveness for performing RCR with BT was maintained with tenodesis implant costs up to $3,048, revision rates up to 6.7%, and additional operative time up to 53.7 minutes.

CONCLUSION: Despite higher upfront costs, performing biceps tenodesis at the time of index rotator cuff repair provides greater quality-adjusted life years and is cost-effective compared to isolated rotator cuff repair at mid-term follow-up.

LEVEL OF EVIDENCE: Level III, Economic Study.