Transarterial Embolization Versus Manipulation Under Anesthesia and Arthroscopic Capsular Release for Refractory Adhesive Capsulitis-A Cost-Effectiveness Analysis.
Kameel Khabaz, Rashed Alananzeh, Layth Alkhani et al.
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In 30 seconds
This systematic review and cost-effectiveness analysis compared transarterial embolization (TAE), manipulation under anesthesia (MUA), and arthroscopic capsular release (ACR) for refractory primary adhesive capsulitis. Single-arm meta-analyses informed a three-state Markov model over 36 months. For clinical success defined as mild pain at 3 months, rates were 73.3% with TAE, 61.4% with ACR, and 55.5% with MUA. At a $100,000 per quality-adjusted life-year threshold, TAE was optimal, with an incremental cost-effectiveness ratio versus ACR of $77,807/QALY; results differed when success was defined by range-of-motion recovery.
Key findings
- Mild-pain success at 3 months was 73.3% for TAE, 61.4% for ACR, and 55.5% for MUA.
- At a $100,000 per QALY threshold, TAE was optimal; its incremental cost-effectiveness ratio versus ACR was $77,807/QALY.
- When success was defined by range-of-motion recovery, MUA and ACR produced more QALYs at lower cost.
Why it matters
The analysis suggests that economic rankings among procedures for refractory adhesive capsulitis depend on the treatment goal used to define success. Pain relief and recovery of range of motion did not favor the same strategies, underscoring the importance of distinguishing these outcomes when interpreting comparative cost-effectiveness evidence.
What to keep in mind
The comparisons were indirect, based on single-arm meta-analyses and a modeled 36-month horizon rather than direct randomized comparisons.