Poster 12: Cost-Effectiveness of Acellular Collagen Matrix Augmentation for Arthroscopic Rotator Cuff Repair: A Markov Analysis

Abstract

Objectives:

Acellular collagen matrix (ACM) augmentation for arthroscopic rotator cuff repair (ARCR) has been shown to reduce re-tear rates and improve outcomes after ARCR, however, the cost-effectiveness of ACM is uncleared. Thus, the purpose of this study is to perform a Markov model-based cost-effectiveness analysis comparing ARCR & ACM to ARCR for symptomatic, medium to large rotator cuff tears.

Methods:

A Markov Chain Monte Carlo probabilistic model was developed to evaluate the outcomes and costs of 1,000 simulated patients undergoing ARCR & ACM versus ARCR for symptomatic, medium to large rotator cuff tears. Health utility values, transition probabilities, and costs were derived from the published literature (Table 1). Outcome measures included costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER). Ten-year costs for each patient in the microsimulation model were averaged by initial treatment strategy to capture costs of any subsequent treatments patients underwent as a result of re-tears. Cycle length was defined as one year, with all costs and utilities discounted at 3% annually. Disutility was applied to patient health states involving conversion to reverse shoulder arthroplasty (RSA) for re-tears and postoperative complications.

Results:

Over the ten-year time horizon, mean total costs resulting from ARCR & ACM and ARCR were $54,461 ± 8,957 and 58,896 ± 8,896, respectively (Table 2). On average, ARCR & ACM was associated with 5.26 ± 0.41 QALYs, while ARCR alone was associated with 3.95 ± 0.43 QALYs. Overall, ARCR & ACM was determined the preferred cost-effective strategy in 99.7% of patients included in the microsimulation model, with ARCR alone predicted to be the preferred strategy in 0.3% of patients. Deterministic sensitivity analysis on the risk for re-tear associated with ARCR & ACM found that the recurrence risk associated with ARCR & ACM would need to be greater than 26.5% in order for ARCR without patch augmentation to be more cost-effective than ARCR & ACM at a willingness-to-pay threshold of $50,000/QALY.

Conclusions:

ARCR & ACM to be the dominant, cost-effective treatment strategy for symptomatic, medium to large rotator cuff tears based on the Monte Carlo microsimulation and probabilistic sensitivity analysis. Patients who underwent ARCR without patch augmentation experienced an increased risk for re-tears that ultimately resulted in an average cost for that exceeds that of the ARCR & ACM cohort due to the increased downstream costs incurred for re-tears.