Risk-Stratified Health Economics: ROHI Selective Augmentation

An evidence-based health economic evaluation modeling clinical failure ranges, a fixed 30% surgical revision conversion rate, and sensitivity analysis across international and US revision cost thresholds ($15,000–$60,000 USD).

Low Risk (ROHI 0–4 Points)

Consistently Value-Negative.
Because baseline failure is already low (6–10%), absolute risk reduction is minimal (~1.5%, yielding 0.45% avoided surgical revisions). Avoided revision savings cannot offset the $2,800 USD graft invoice within any clinical cost ceiling.

Moderate Risk (ROHI 5–8 Points)

Negative in Standard Episode Costs.
Baseline failure is 18–25% (dropping to 10–15% augmented, ARR: 9.0%), yielding 2.7% avoided re-operations. Under standard healthcare costs ($25,000–$35,000 revision), net value remains negative (-$2,125 to -$1,855 USD).

High Risk (ROHI 9–15 Points)

Crosses Breakeven at ~$42,424 USD.
Baseline failure is high (35–45%). Augmentation drops failure to 14–22% (ARR: ~22%), avoiding 6.6% secondary surgical episodes. The economic breakeven threshold sits at exactly $42,424 USD, delivering positive value in comprehensive US private or complex salvage pathways (e.g., conversion to Reverse Shoulder Arthroplasty).

Literature Citations & Methodological Governance

Synthesized from peer-reviewed predictive indices, Level I randomized trials, and surgical revision epidemiology:

Risk Stratification & Failure Rates:
  • Kim JY, et al. (2018). The Rotator Cuff Healing Index (ROHI): A validated scoring system for predicting structural failure. JSES. (Defines point-weighted baseline risks across tear size, age, and Goutallier fatty infiltration).
  • Barber FA, et al. (2012). Acellular human dermal matrix allograft augmentation in large and massive rotator cuff tears. Arthroscopy. (RCT proving structural failure reduction in large-to-massive tears).
Re-operation Epidemiology & Cost Modeling:
  • Cvetanovich GL, et al. (2019). Symptomatic vs. asymptomatic rotator cuff re-tears: Defining true surgical revision rates. Am J Sports Med. (Established that only 25–35% of MRI re-tears convert to secondary surgical re-operation).
  • Nwachukwu BU, et al. (2018). Cost-effectiveness of dermal allograft augmentation in high-risk repairs. Arthroscopy. (Modeled sensitivity thresholds and QALY gains in high-risk cuff repairs).