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Objectives and questions: Numerous produce suture anchors in rotator cuff reconstruction surgery with varying cost-effectiveness. Previous research has explored cost effectiveness including knotted versus knotless suture techniques. The aim of this study is to conduct a cost-effectiveness analysis comparing suture anchors from two different manufacturers.

Material and methods: Using a retrospective local registry, we included patients undergoing arthroscopic rotator cuff repair utilizing anchors from two manufacturers. Data analysis was conducted via multiple linear regression, evaluating the relationship between total surgical costs and various factors such as adjusted life years, manufacturer, anchor configuration controlling for sex, tear severity, and age. Costs were obtained from the clinical billing department.

Results: 317 patients were included with a mean age at surgery of 60.1±10.8 years with 58% of patients being male. 23% of patients had one partial tear, 37% had one full tear, 22% showed two or three torn tendons, the remaining 18% had a massive tear. Using linear regression models, the analysis of changes in quality-adjusted life years as the dependent variable did not yield statistically significant results. However, the model evaluating costs identified significant effects related to the manufacturer and anchor configuration. The manufacturer had a significant effect on costs (b=363.70, p<0.001), controlling for age, sex, tear severity, and anchor configuration. Regarding anchor configurations, two lateral anchors and one medial anchor were associated with lower costs compared to the reference group (two medial and two lateral anchors) (b=−268.41, p=0.01). Similarly, one medial and one lateral anchor resulted in lower costs compared to the reference group (b=−254.65, p=0.0005). Additionally, using one medial and two lateral anchors was also associated with reduced costs (b=−131.88, p=0.01) controlling for age, sex, tear severity, and manufacturer. The Incremental cost-effectiveness ratio calculated at CHF 6.91 per adjusted life year was not statistically significant (p = 0.156). Anchors from manufacturer 1 were associated with significantly lower costs compared to anchors from manufacturer 2 (cost difference of CHF 433.85, p<0.001). The overall regression model explained 22.6% of the variance in costs (Adjusted R²=0.18, p<0.001).

Discussion and conclusions: The results of this study revealed that while clinical outcomes remain consistent across different rotator cuff rupture profiles and among various surgeons, suture anchors from a specific manufacturer show greater cost-effectiveness. The differences are primarily driven by the manufacturer and the number of anchors used, highlighting the significant impact of anchor manufacturer and quantity on cost variability.