The Cost-Effectiveness of Utilizing Platelet-Rich Plasma During Rotator Cuff Repair

Abstract

Objectives:A certain percentage of repaired rotator cuffs do not heal postoperatively. There has been significant interest in enhancing the healing potential of repaired rotator cuffs using biologic factors such as cytokines, gene therapy, scaffolds, mesenchymal stem cells, etc. Platelet-rich plasma (PRP) has been one of the most studied of these biologic factors. The purpose of this study was to determine whether or not PRP augmentation of rotator cuff repair (RCR) is cost-effective.Methods:Utility values, retear rates, and transition probabilities were derived from the best evidence available in the literature regarding rotator cuff tears, their repair, and the augmentation of the repair with PRP. Costs were determined by examining the typical patient undergoing treatment for a full-thickness rotator cuff tear in a private orthopaedic clinic and outpatient surgery center. (Table 1) A Markov decision model was constructed using this data to perform a cost-effectiveness analysis. (Figure)Results:The cost per quality-adjusted life year ($/QALY) of RCR with and without PRP was $6775/QALY and $6612/QALY respectively. In the base case scenario, the use of PRP to augment RCR was not cost-effective as it had exactly the same ‘effectiveness’ as RCR without PRP augmentation while being associated with a higher cost (additional $750). Sensitivity analysis revealed that in order to achieve a willingness-to-pay threshold of $50,000/QALY, the addition of PRP would need to be associated with a 9.1% reduction in retears. If the cost of PRP were increased to $1000, the retear rate would need to be reduced 12.1% in order to reach this same threshold. This compared to a reduction of only 6.1% if the additional cost of PRP was $500. (Table 2)Conclusion:This cost-effectiveness analysis reveals that, currently, the use of PRP to augment RCR is not cost-effective. Sensitivity analysis evealed that PRP augmented repairs would have to show a reduced retear rate of at least 9.1% before its additional cost would be considered cost-effective. Future research needs to show a significant and reliable reduction in retear rates or improvement in outcomes before PRP augmented RCR can be considered cost-effective.