The Cost-Effectiveness Of Arthroscopic Bankart Repair Versus Non-Operative Treatment For First-time, Traumatic, Anterior Shoulder Dislocations

作者：Ryan P. Donegan, Garrett Davis, James Genuario, John Erik Bell · 发表于：Orthopaedic Journal of Sports Medicine · 年份：2013 · DOI：10.1177/2325967113s00014 · 被引用次数：1 · 研究领域：Shoulder Injury and Treatment、Shoulder and Clavicle Injuries

Objectives: Prior studies have demonstrated excellent results after acute arthroscopic stabilization of first-time, traumatic, anterior shoulder dislocations in young patients. However, this treatment has not been widely accepted as first line management of this injury. Surgeons may point to the initial direct costs of surgical management as one rationale for conservative management of these injuries. The purpose of this study is to determine whether surgical stabilization of first time traumatic anterior shoulder dislocation represents a cost effective treatment alternative when compared to non-operative treatment with physical therapy. Methods: A decision-analytic model was constructed to assess the cost-effectiveness of arthroscopic bankart repair compared with non-operative treatment with physical therapy based on the incremental cost-effectiveness ratio (ICER). A threshold ICER of less than $100,000/quality adjusted life year gained was set to define a cost-effective treatment modality. Health state utilities for treatment outcomes of a recurrently dislocating shoulder and a stable shoulder were collected prospectively by surveying fifty patient volunteers using a time trade-off Method: The probabilities of the various treatment outcomes and the costs associated with treatment were derived from the orthopaedic literature and adjusted Medicare reimbursement rates. Results: The incremental cost-effectiveness ratio (ICER) for arthroscopic bankart versus non-operative treatm...