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<p>This study compared the cost-effectiveness of transarterial embolization (TAE), manipulation under anesthesia (MUA), and arthroscopic capsular release (ACR) for refractory primary adhesive capsulitis. A systematic review with single-arm meta-analyses informed a three-state Markov model over a 36-month horizon. Clinical success, defined as mild pain at 3 months, was highest for TAE (73.3%), followed by ACR (61.4%) and MUA (55.5%). At a $100,000 per quality-adjusted life-year (QALY) threshold, TAE was the optimal strategy (incremental cost-effectiveness ratio vs. ACR: $77,807/QALY). When success was defined by range-of-motion recovery, MUA and ACR yielded more QALYs at lower cost. Based on indirect comparisons, these findings suggest TAE may be a cost-effective option for pain-predominant adhesive capsulitis, while MUA and ACR may be preferred when mechanical restriction is the primary target.</p> Graphical Abstract

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Transarterial Embolization Versus Manipulation Under Anesthesia and Arthroscopic Capsular Release for Refractory Adhesive Capsulitis—A Cost-Effectiveness Analysis

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年8月2日

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  • Kameel Khabaz,
  • Rashed Alananzeh,
  • Layth Alkhani,
  • Sammy Allaw,
  • Xiao Wu,
  • Qian Yu,
  • Mikin Patel,
  • Osman Ahmed

摘要

This study compared the cost-effectiveness of transarterial embolization (TAE), manipulation under anesthesia (MUA), and arthroscopic capsular release (ACR) for refractory primary adhesive capsulitis. A systematic review with single-arm meta-analyses informed a three-state Markov model over a 36-month horizon. Clinical success, defined as mild pain at 3 months, was highest for TAE (73.3%), followed by ACR (61.4%) and MUA (55.5%). At a $100,000 per quality-adjusted life-year (QALY) threshold, TAE was the optimal strategy (incremental cost-effectiveness ratio vs. ACR: $77,807/QALY). When success was defined by range-of-motion recovery, MUA and ACR yielded more QALYs at lower cost. Based on indirect comparisons, these findings suggest TAE may be a cost-effective option for pain-predominant adhesive capsulitis, while MUA and ACR may be preferred when mechanical restriction is the primary target.

Graphical Abstract