The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Is Arthroscopic Latarjet a Cost-Effective Procedure? A Decision Analysis

Document Type : RESEARCH PAPER

Authors
Ryan Lopez
Benjamin Zmistowski
Benjamin A. Hendy
Cassandra Sanko
Alexis Williams
Charles L. Getz
Joseph A Abboud
Surena Namdari
The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, Philadelphia, PA, USA
10.22038/abjs.2023.73800.3430
Abstract
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
Keywords
Arthroscopic latarjet
Cost analysis
Latarjet procedure
Shoulder instability
Subjects
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The Archives of Bone and Joint Surgery
Volume 12, Issue 1
January 2024
Pages 12-18

  • Receive Date 15 August 2023
  • Revise Date 07 November 2023
  • Accept Date 30 October 2023