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Common treatment strategies for calcium hydroxyapatite deposition disease: a cost-effectiveness analysis

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Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

To determine the cost-effectiveness of rotator cuff hydroxyapatite deposition disease (HADD) treatments.

Method

A 1-year time horizon decision analytic model was created from the US healthcare system perspective for a 52-year-old female with shoulder HADD failing conservative management. The model evaluated the incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB) of standard strategies, including conservative management, ultrasound-guided barbotage (UGB), high- and low-energy extracorporeal shock wave therapy (ECSW), and surgery. The primary effectiveness outcome was quality-adjusted life years (QALY). Costs were estimated in 2022 US dollars. The willingness-to-pay (WTP) threshold was $100,000.

Results

For the base case, UGB was the preferred strategy (0.9725 QALY, total cost, $2199.35, NMB, $95,048.45, and ICER, $33,992.99), with conservative management (0.9670 QALY, NMB $94,688.83) a reasonable alternative. High-energy ECSW (0.9837 QALY, NMB $94,805.72), though most effective, had an ICER of $121, 558.90, surpassing the WTP threshold. Surgery (0.9532 QALY, NMB $92,092.46) and low-energy ECSW (0.9287 QALY, NMB $87,881.20) were each dominated. Sensitivity analysis demonstrated that high-energy ECSW would become the favored strategy when its cost was < $2905.66, and conservative management was favored when the cost was < $990.34. Probabilistic sensitivity analysis supported the base case results, with UGB preferred in 43% of simulations, high-energy ECSW in 36%, conservative management in 20%, and low-energy ECSW and surgery in < 1%.

Conclusion

UGB appears to be the most cost-effective strategy for patients with HADD, while surgery and low-energy ECSW are the least cost-effective. Conservative management may be considered a reasonable alternative treatment strategy in the appropriate clinical setting.

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Authors and Affiliations

  1. Department of Radiology, NYU Langone Health, 301 E 17Th Street, 6Th Floor, New York, NY, 10010, USA

    Erin F. Alaia, Madalena Da Silva Cardoso & Soterios Gyftopoulos

  2. Department of Radiology, Cleveland Clinic, Mail Code A21, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Naveen Subhas

  3. Department of Orthopedic Surgery, NYU Langone Health, 333 East 38Th Street, 4Th Floor, New York, NY, 10016, USA

    Zachary I. Li, Mehul R. Shah, Michael J. Alaia & Soterios Gyftopoulos

  4. Tufts School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA

    Zachary I. Li

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  1. Erin F. Alaia
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  2. Naveen Subhas
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Correspondence to Erin F. Alaia.

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Conflict of interest

Erin F. Alaia is a paid Consultant of Biorez, Inc. (unrelated). Michael J. Alaia is a paid Consultant of JRF, Bodycad, and Mitek and received research support from Orcosa and Arthrex (unrelated). Naveen Subhas, Madalena Da Silva Cardoso, Zachary I. Li, Mehul R. Shah, and Soterios Gyftopoulos declare no competing interests.

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Alaia, E.F., Subhas, N., Da Silva Cardoso, M. et al. Common treatment strategies for calcium hydroxyapatite deposition disease: a cost-effectiveness analysis. Skeletal Radiol 53, 437–444 (2024). https://doi.org/10.1007/s00256-023-04424-2

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  • DOI: https://doi.org/10.1007/s00256-023-04424-2

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