The Rotator Cuff Repair Debate Continues: Double or Single Row?

By: Maria Shepherd, Data Decision Group

Between 2005 and 2012 (estimated), U.S. rotator cuff repair procedure rates were projected to grow by a 4 percent compound annual growth rate to 485,902 procedures per year.¹ Shoulder pain often is cited by as among the most common musculoskeletal disorders, with 27 percent of patients reporting painful shoulder joints.²


Why It’s Important
Rotator cuff repair (RCR) is a well-established procedure that has been reported to be cost-effective and have comparable outcomes for arthroscopic and open procedures.^3,4 In a recent article in The Journal Of Bone And Joint Surgery titled “The Cost-Effectiveness of Single-Row Compared with Double-Row Arthroscopic Rotator Cuff Repair,” authors expressed concerns that traditional surgery using single-row fixation for arthroscopic RCR has been challenged due to doubts about fixation strength and repair integrity.^5,6

Chart 1. Cost Assumptions of a Single-Row RCR, Using Institutional Data5

The study’s authors cite several studies that attempt to prove superior outcomes with arthroscopic double-row repairs, but also claim that no clinical study has demonstrated a functional improvement in patient outcomes. This paper examines current data to understand if arthroscopic double-row rotator cuff repair is a truly cost-effective alternative to traditional single-row arthroscopic RCR fixation, based on implant costs and the increase required in operating room time for the second row of fixation. The authors believe that in the current healthcare environment it is important to ensure that patients receiving RCR receive the most cost- and outcome-effective treatments.

Chart 2. Assumptions of the Incremental Costs of a Double-Row RCR, Using Institutional Data5

The Journal article looked at many other variables as well, such as size of rotator cuff tears (less than 3 centimeters versus greater than or equal to 3 centimeters), re-tear rates and quality-adjusted life years (QALYs; a measure of disease burden). They constructed a model using large randomized trials and developed a base case analysis. Based on the costs, QALYs and probabilities used in the base case, they determined that single-row rotator cuff repair is less costly than double-row repair for all size tears.

Chart 3. Cost Assumptions of Single-Row vs. Double-Row RCR, Using Institutional Data5

What a Difference a Decade Makes
Ten years ago, very few U.S. orthopedic surgeons or hospital administrators would examine the cost differential behind these two types of RCR. The advent of healthcare reform, surgeon-owned outpatient centers and many other factors have changed clinician opinions and attitudes about product costs. Be sure that your product is cost effective compared to the competition. If your marketing department doesn’t know the answers to questions about cost-effectiveness, be careful. It may be a surgeon who finds the answer for your product.

References:

1. www.pearldiverinc.com
2. Ibid
3. Vitale MA, Vitale MG, Zivin JG, Braman JP, Bigliani LU, Flatow EL. Rotator cuff repair: an analysis of utility scores and cost-effectiveness. J Shoulder Elbow Surg. 2007;16:181-7
4. Bennett WF. Arthroscopic repair of massive rotator cuff tears: a prospective cohort with 2- to 4-year follow-up. Arthroscopy. 2003;19:380-90
5. Genuario, J. et. al, Bone Joint Surg Am. 2012;94:1369-77
6. Sugaya H, Maeda K, Matsuki K, Moriishi J. Repair integrity and functional outcome after arthroscopic double-row rotator cuff repair. A prospective outcome study. J Bone Joint Surg Am. 2007;89:953-60

Editor’s note: Readers are invited to submit market data and trend questions to Maria Shepherd. Periodically, selected questions will be presented in this column, with answers from Maria. Send your questions to the email in her bio (below).

Maria Shepherd, founder of Data Decision Group, has 20 years of leadership experience in medical device and life sciences marketing. Following a career including serving as vice president of marketing for Oridion Medical; director of marketing for Philips Medical; and senior management roles at Boston Scientific Inc., she founded Data Decision Group. Her firm quantitatively and qualitatively sizes opportunities, evaluates new technologies, and assesses prospective acquisitions for medtech companies. Shepherd teaches marketing and product development courses and recently was appointed to the board of the MSBiV Medtech Investment Committee. She can be reached at (617) 548-9892 and [email protected].