{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T01:09:24Z","timestamp":1793408964232,"version":"4.5.0"},"reference-count":41,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2012,10,8]],"date-time":"2012-10-08T00:00:00Z","timestamp":1349654400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2012,10,8]],"date-time":"2012-10-08T00:00:00Z","timestamp":1349654400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2012,10,8]],"date-time":"2012-10-08T00:00:00Z","timestamp":1349654400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2012,10,8]],"date-time":"2012-10-08T00:00:00Z","timestamp":1349654400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"funder":[{"DOI":"10.13039\/100007307","name":"Arthrex","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007307","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009026","name":"Smith and Nephew","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009026","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["arthroscopyjournal.org","clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"published-print":{"date-parts":[[2012,12]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The purpose of this study was to compare the cost\u2010effectiveness of initial observation versus surgery for first\u2010time anterior shoulder dislocation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The clinical scenario of first\u2010time anterior glenohumeral dislocation was simulated using a Markov model (where variables change over time depending on previous states). Nonoperative outcomes include success (no recurrence) and recurrence; surgical outcomes include success, recurrence, and complications of infection or stiffness. Probabilities for outcomes were determined from published literature. Costs were tabulated from Medicare Current Procedural Terminology data, as well as hospital and office billing records. We performed microsimulation and probabilistic sensitivity analysis running 6 models for 1,000 patients over a period of 15 years. The 6 models tested were male versus female patients aged 15 years versus 25 years versus 35 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Primary surgery was less costly and more effective for 15\u2010year\u2010old boys, 15\u2010year\u2010old girls, and 25\u2010year\u2010old men. For the remaining scenarios (25\u2010year\u2010old women and 35\u2010year\u2010old men and women), primary surgery was also more effective but was more costly. However, for these scenarios, primary surgery was still very cost\u2010effective (cost per quality\u2010adjusted life\u2010year, &lt;$25,000). After 1 recurrence, surgery was less costly and more effective for all scenarios.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Primary arthroscopic stabilization is a clinically effective and cost\u2010effective treatment for first\u2010time anterior shoulder dislocations in the cohorts studied. By use of a willingness\u2010to\u2010pay threshold of $25,000 per quality\u2010adjusted life\u2010year, surgery was more cost\u2010effective than nonoperative treatment for the majority of patients studied in the model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level II, economic and decision analysis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.arthro.2012.05.885","type":"journal-article","created":{"date-parts":[[2012,10,5]],"date-time":"2012-10-05T12:33:06Z","timestamp":1349440386000},"page":"1755-1765","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":72,"title":["Cost\u2010Effectiveness Analysis of Primary Arthroscopic Stabilization Versus Nonoperative Treatment for First\u2010Time Anterior Glenohumeral Dislocations"],"prefix":"10.1002","volume":"28","author":[{"given":"Timothy 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