Title: Real-world cost-utility analysis of arthroscopic rotator cuff repair in Switzerland
Authors : Meier, Flurina
Brunner, Beatrice
Grobet, Cécile
Wieser, Simon
Audigé, Laurent
Flury, Matthias
Eichler, Klaus
Conference details: Swiss Public Health Conference 2018, Neuchâtel, 07-08 November 2018
Publisher / Ed. Institution : Swiss School of Public Health (SSPH+)
Issue Date: 2018
License (according to publishing contract) : Licence according to publishing contract
Type of review: No review
Language : English
Subject (DDC) : 617.5: Orthopaedic surgery
Abstract: Objectives: Knowledge about benefit and costs of orthopaedic interventions is important for patients, surgeons, health policy decision makers and health care payers. Little is known about the impact of orthopaedic upper extremity procedures on quality of life (QOL) and costs in real world settings and to our knowledge, no previous investigation assessed this for Switzerland. Therefore, we conducted a cost-utility analysis for arthroscopic rotator cuff repair (aRCR), an established therapy to treat rotator cuff tear of the shoulder. We assessed changes in QOL, direct medical costs and productivity losses from a societal perspective. Methods: All consecutive patients with an indication for aRCR from a large orthopaedic centre in Switzerland were included in our study. Patients served as their own controls with data from the year before surgery. They completed a QOL questionnaire (EQ-5D-5L [Utilities: 0-1]) as well as the work productivity and activity impairment questionnaire (WPAI) seven times throughout the study (period of analysis: 1 year pre-operation (OP) until 2 years post-OP). 16 major insurance companies provided direct medical cost data over the entire study period. The health economic analysis was performed from a societal perspective including total costs (direct medical costs and productivity losses). Incremental costs per quality adjusted life year (QALY) gained were estimated by non-parametric bootstrapping for all patients Results: 153 patients (mean: 56.9 years; male: 63%) received an aRCR OP. QOL improved over time from 0.67 (pre-OP) to 0.94 (1 year post-OP) and 0.96 (2 years post-OP). The mean QALY gain was 0.207 (95%-CI: 0.168 to 0.246) compared to the pre-OP period. Mean total costs increased from CHF 7’868 (year pre-OP) to CHF 18’529 (first year post-OP) and decreased below the pre-OP level in the second year after surgery (CHF 4’558). The incremental cost-utility ratio for aRCR was CHF 16’261/QALY gained (95%-CI: CHF 7’963 to 24’558/QALY) until two years post-OP compared to the pre-OP period. Discussion: aRCR shows a cost-utility ratio clearly below the often-suggested CHF 100'000/QALY threshold for Switzerland. The collected real-world data provides evidence for good value in health care as provided in a Swiss orthopaedic centre. The applied methodology may be recommended for real-world cost-utility studies of common medical procedures in Swiss routine care.
Departement: School of Management and Law
Organisational Unit: Winterthur Institute of Health Economics (WIG)
Publication type: Conference Poster
URI: https://digitalcollection.zhaw.ch/handle/11475/15384
Appears in Collections:Publikationen School of Management and Law

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