Objectives: Arthroscopic Latarjet for glenohumeral stabilization has emerged as an alternative to the
open approach; however, the evidence to date has questioned if this technique delivers improved
outcomes. This analysis provides an assessment of the cost and utility associated with arthroscopic
versus open Latarjet.
Methods: The cost-effectiveness of Latarjet stabilization was modeled over a ten-year period. Institutional cases
were reviewed for equipment utilization. Cost data from ambulatory surgical centers was obtained for each piece of
equipment used intraoperatively. Based upon prior analyses, the operating room cost was assigned a value of
$36.14 per minute. To determine effectiveness, a utility score was derived based upon prior analysis of shoulder
stabilization using the EuroQol (EQ) 5D. For reoperations, a utility score of 0.01 was assigned for a single year for
revision surgeries for instability and 0.5 for minor procedures. Probability of surgical outcomes and operative time
for arthroscopic and open Latarjet were taken from prior studies comparing outcomes of these procedures. Decisiontree analysis utilizing these values was performed.
Results: Based upon equipment and operating room costs, arthroscopic Latarjet was found to cost $2,796.87 more
than the equivalent open procedure. Analysis of the utility of these procedures were 1.330 and 1.338 quality adjusted
life years obtained over the modeled period for arthroscopic versus open Latarjet, respectively. For arthroscopic
Latarjet to be cost-equivalent to open Latarjet, surgical time would need to be reduced to 41.5 minutes or the surgical
equipment would need to be provided at no expense, while maintaining the same success rates.
Conclusion: With nearly identical utility scores favoring open surgery, the added cost associated with arthroscopic
Latarjet cannot be supported with available cost and utility data. To provide value, additional benefits such as
decreased post-operative narcotic utilization, decreased blood loss, or lower complications of the arthroscopic
approach must be demonstrated.
Level of evidence: IV |
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