Primary Bankart Repair Versus Arthroscopic Anatomic Glenoid Reconstruction in Patients with Subcritical Bone Loss

Background:. Anterior shoulder instability and its treatment is a quickly evolving field of interest in orthopaedics, both for patients and for health-care systems. In this study, we aimed to evaluate the cost-effectiveness of arthroscopic anatomic glenoid reconstruction (AAGR) compared with Bankart...

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Autores principales:	Zakariya S. Ali, MD, Kednapa Thavorn, BPharm, MPharm, PhD, Ryland Murphy, BSc, Sara Sparavalo, BSc, MASc, Ivan Wong, MD, FRCSC, MAcM, DipSportsMed, FAANA
Formato:	article
Lenguaje:	EN
Publicado:	Wolters Kluwer 2021
Materias:	Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/c7ac266f02b845e78ffb6d66e0c0726f
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spelling	oai:doaj.org-article:c7ac266f02b845e78ffb6d66e0c0726f2021-11-25T07:59:02ZPrimary Bankart Repair Versus Arthroscopic Anatomic Glenoid Reconstruction in Patients with Subcritical Bone Loss2472-724510.2106/JBJS.OA.21.00067https://doaj.org/article/c7ac266f02b845e78ffb6d66e0c0726f2021-12-01T00:00:00Zhttp://journals.lww.com/jbjsoa/fulltext/10.2106/JBJS.OA.21.00067https://doaj.org/toc/2472-7245Background:. Anterior shoulder instability and its treatment is a quickly evolving field of interest in orthopaedics, both for patients and for health-care systems. In this study, we aimed to evaluate the cost-effectiveness of arthroscopic anatomic glenoid reconstruction (AAGR) compared with Bankart repair in the treatment of anterior shoulder instability in patients with subcritical glenoid bone loss. Methods:. A cost-utility analysis was performed from the perspective of Canada’s publicly funded health-care system. A decision-tree model was created to simulate the progression of patients undergoing either a primary Bankart repair or AAGR. Recently published data were used to determine the recurrence rate and level of glenoid bone loss for the AAGR procedure; the recurrence rate was 1.4% in a cohort with a mean glenoid bone loss of 25.3%. A literature review on the primary Bankart procedure in patients with at least subcritical levels of glenoid bone loss yielded a recurrence rate of 22.9% in patients with a mean glenoid bone loss of 17.5%. AAGR served as the revision surgery for both primary procedures. Health utility scores for anterior shoulder instability were obtained from published literature. Total procedure costs, including costs of operating-room consumables, anesthesia, diagnostic imaging, and rehabilitation, were sourced from a hospital database. A probabilistic sensitivity analysis using 5,000 Monte Carlo simulations was performed, and results were used to create a cost-effectiveness acceptability curve. Results:. The AAGR procedure was less costly and led to an improvement in quality-adjusted life years (QALYs) when compared with the arthroscopic Bankart repair in the treatment of patients with anterior shoulder instability with subcritical glenoid bone loss (AAGR, cost = $16,682.77 [Canadian dollars] and QALYs = 5.76; Bankart, cost = $16,720.29 and QALYs = 5.46), suggesting that the AAGR is dominant, i.e., lower costs with higher QALYs. Applying a commonly used willingness-to-pay threshold of $50,000 per QALY gained, the probability that the primary AAGR was more cost-effective was 85.8%. Conclusions:. This study showed that, from the perspective of a publicly funded health-care system, AAGR was the economical treatment option when compared with Bankart repair in anterior shoulder instability with subcritical glenoid bone loss. Level of Evidence:. Economic and Decision Analysis Level III. See Instructions for Authors for a complete description of levels of evidence.Zakariya S. Ali, MDKednapa Thavorn, BPharm, MPharm, PhDRyland Murphy, BScSara Sparavalo, BSc, MAScIvan Wong, MD, FRCSC, MAcM, DipSportsMed, FAANAWolters KluwerarticleOrthopedic surgeryRD701-811ENJBJS Open Access, Vol 6, Iss 4 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Orthopedic surgery RD701-811
spellingShingle	Orthopedic surgery RD701-811 Zakariya S. Ali, MD Kednapa Thavorn, BPharm, MPharm, PhD Ryland Murphy, BSc Sara Sparavalo, BSc, MASc Ivan Wong, MD, FRCSC, MAcM, DipSportsMed, FAANA Primary Bankart Repair Versus Arthroscopic Anatomic Glenoid Reconstruction in Patients with Subcritical Bone Loss
description	Background:. Anterior shoulder instability and its treatment is a quickly evolving field of interest in orthopaedics, both for patients and for health-care systems. In this study, we aimed to evaluate the cost-effectiveness of arthroscopic anatomic glenoid reconstruction (AAGR) compared with Bankart repair in the treatment of anterior shoulder instability in patients with subcritical glenoid bone loss. Methods:. A cost-utility analysis was performed from the perspective of Canada’s publicly funded health-care system. A decision-tree model was created to simulate the progression of patients undergoing either a primary Bankart repair or AAGR. Recently published data were used to determine the recurrence rate and level of glenoid bone loss for the AAGR procedure; the recurrence rate was 1.4% in a cohort with a mean glenoid bone loss of 25.3%. A literature review on the primary Bankart procedure in patients with at least subcritical levels of glenoid bone loss yielded a recurrence rate of 22.9% in patients with a mean glenoid bone loss of 17.5%. AAGR served as the revision surgery for both primary procedures. Health utility scores for anterior shoulder instability were obtained from published literature. Total procedure costs, including costs of operating-room consumables, anesthesia, diagnostic imaging, and rehabilitation, were sourced from a hospital database. A probabilistic sensitivity analysis using 5,000 Monte Carlo simulations was performed, and results were used to create a cost-effectiveness acceptability curve. Results:. The AAGR procedure was less costly and led to an improvement in quality-adjusted life years (QALYs) when compared with the arthroscopic Bankart repair in the treatment of patients with anterior shoulder instability with subcritical glenoid bone loss (AAGR, cost = $16,682.77 [Canadian dollars] and QALYs = 5.76; Bankart, cost = $16,720.29 and QALYs = 5.46), suggesting that the AAGR is dominant, i.e., lower costs with higher QALYs. Applying a commonly used willingness-to-pay threshold of $50,000 per QALY gained, the probability that the primary AAGR was more cost-effective was 85.8%. Conclusions:. This study showed that, from the perspective of a publicly funded health-care system, AAGR was the economical treatment option when compared with Bankart repair in anterior shoulder instability with subcritical glenoid bone loss. Level of Evidence:. Economic and Decision Analysis Level III. See Instructions for Authors for a complete description of levels of evidence.
format	article
author	Zakariya S. Ali, MD Kednapa Thavorn, BPharm, MPharm, PhD Ryland Murphy, BSc Sara Sparavalo, BSc, MASc Ivan Wong, MD, FRCSC, MAcM, DipSportsMed, FAANA
author_facet	Zakariya S. Ali, MD Kednapa Thavorn, BPharm, MPharm, PhD Ryland Murphy, BSc Sara Sparavalo, BSc, MASc Ivan Wong, MD, FRCSC, MAcM, DipSportsMed, FAANA
author_sort	Zakariya S. Ali, MD
title	Primary Bankart Repair Versus Arthroscopic Anatomic Glenoid Reconstruction in Patients with Subcritical Bone Loss
title_short	Primary Bankart Repair Versus Arthroscopic Anatomic Glenoid Reconstruction in Patients with Subcritical Bone Loss
title_full	Primary Bankart Repair Versus Arthroscopic Anatomic Glenoid Reconstruction in Patients with Subcritical Bone Loss
title_fullStr	Primary Bankart Repair Versus Arthroscopic Anatomic Glenoid Reconstruction in Patients with Subcritical Bone Loss
title_full_unstemmed	Primary Bankart Repair Versus Arthroscopic Anatomic Glenoid Reconstruction in Patients with Subcritical Bone Loss
title_sort	primary bankart repair versus arthroscopic anatomic glenoid reconstruction in patients with subcritical bone loss
publisher	Wolters Kluwer
publishDate	2021
url	https://doaj.org/article/c7ac266f02b845e78ffb6d66e0c0726f
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Primary Bankart Repair Versus Arthroscopic Anatomic Glenoid Reconstruction in Patients with Subcritical Bone Loss

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