Important information on coronavirus: Please see our information on Covid certification requirements from 4 October. Learn more

News Does rotator cuff (shoulder tendon tear) repair make economic sense?

From a health perspective, the repair of a torn rotator cuff (should tendon) can be beneficial to many patients. But does the surgical procedure also make economic sense? Our team of researchers and doctors joined forces with the Winterthur Institute of Health Economics and 16 major Swiss insurance providers to investigate this very question, using a cost-utility analysis of arthroscopic rotator cuff repair.

Not all shoulder tendon tears require surgical intervention. Tendon repair is, however, recommended in some cases, particularly if the tear has been caused by trauma (accident) or if the aim is to prevent increasing degeneration or fatty infiltration of the muscles in the case of a tear which impairs the patient in some way. An operation should also be considered if long-term non-surgical measures have not led to a satisfactory improvement in patients with a tear caused by wear.
Many scientific studies highlight the medical benefits of operations, which is not only useful, but also generally interesting, especially for patients. But what about the economic benefits of an operation of this kind? Against the backdrop of increasing healthcare costs and associated rising healthcare insurance premiums, the demand for proven cost efficiency is becoming more and more important.

Cost-effective surgical procedure boosting quality of life

The study compared shoulder function and quality of life in 153 patients, along with the costs both before and after the operation. The costs includes included both direct medical costs and loss of productivity at work. 

The study's cost-utility analysis shows that arthroscopic rotator cuff repair is a cost-effective surgical procedure which significantly improves patients’ quality of life. Patients’ quality of life had already clearly increased three months after the surgery and their shoulder function also improved substantially. 
The medical costs rose in the year of the operation, but dropped to below the pre-operative level the following year. The costs arising from loss of productivity (as a result of absence from work and/or restrictions when working) dropped substantially as early as during the year of the surgery itself. 106 of the 110 working patients (96%) returned to work, after 2.5 months on average. Just 16 weeks after the operation, the loss of productivity was lower than it was before the operation. 
When the improvement in quality of life is offset against the costs, the cost-benefit utility ratio is significantly clearly below the disputed threshold in Switzerland to be deemed a cost-effective surgical procedure.

First cost-utility analysis with actual costs and clinical data

In Switzerland, there has so far been no cost-benefit analysis in the field of shoulder surgery involving the use of actual costs and clinical data. The only analyses available were based on models or data from the literature. The Schulthess Klinik is the first to record shoulder function and quality of life in patients at various points in time, as well as all costs before and after the operation, together with the Winterthur Institute for Health Economics and major health and accident insurance companies. 

To the study «Cost-utility analysis of arthroscopic rotator cuff repair: A prospective health economic study using real-world data»