Costs, quality of life and cost-effectiveness of arthroscopic and open repair for rotator cuff tears: an economic evaluation alongside the UKUFF trial

AIMS
A trial-based comparison of resource use, costs and quality of life outcomes of open and arthroscopic surgical management for rotator cuff tears in the United Kingdom National Health Service (UK NHS) was performed using individual participant data from the UKUFF randomised controlled trial.
METHODS
Using data from 273 participants, healthcare-related resource use, costs and quality-adjusted life years (QALYs) were estimated at 12 months and 24 months after surgery on an intention to treat basis with adjustment for covariates. Uncertainty around the incremental cost-effectiveness ratio (ICER) for arthroscopic versus open management at 24 months of follow-up was incorporated using bootstrapping. Multiple imputation methods were used to deal with missing data.
RESULTS
There were no significant differences between the open and arthroscopic groups in terms of total mean resource use, cost or QALYs at any follow-up point. Open management dominated arthroscopic management in 59.8% of bootstrapped cost and effect differences. The probability that arthroscopic management was cost-effective compared to open management at a willingness-to-pay threshold of £20 000 per QALY gained was 20.9%.
CONCLUSION
There was no significant overall difference in resource use, costs or quality of life between open and arthroscopic management in the trial. There was uncertainty around which strategy was most cost-effective.