Purpose: Rotator cuff tear (RCT) is a common injury in adults over 50, causing significant pain and functional impairment. This review compares the cost-effectiveness of various surgical and non-surgical RCT treatment options.
Methods: A systematic review was conducted, including cost analyses, randomized controlled trials, and feasibility studies published up to October 2023. Participants had clinically diagnosed RCT confirmed by magnetic resonance imaging. Both conservative and surgical treatments were included. Outcomes measured were cost-effectiveness parameters, like incremental cost-effectiveness ratios or quality-adjusted life years (QALYs), and clinical effectiveness.
Results: The review included 26 studies involving 174,335 patients aged 16 to 88. Surgical interventions, particularly arthroscopic rotator cuff repair (aRCR) and reverse total shoulder arthroplasty (RTSA), were mainly evaluated. Double-row repairs, although more costly, provided better outcomes and tendon healing. Non-operative treatments, while initially cheaper, resulted in lower QALY gains. Delayed surgery led to higher costs and less favorable outcomes. Methodological quality varied, with significant bias due to small sample sizes and short follow-ups.
Conclusions: Both surgical and conservative treatments have benefits, but cost-effectiveness varies. aRCR is cost-effective, especially in terms of QALYs gained. RTSA, despite higher initial costs, offers significant QALY gains for severe cases. Non-operative treatments yield lower QALY gains compared with surgery. Delayed surgery increases overall costs and reduces cost-effectiveness due to prolonged pain management and rehabilitation needs. High-quality, long-term studies are needed to reach definitive conclusions.
