Key message

We have conducted a rapid HTA of subacromial decompression surgery for impingement syndrome on behalf of the Commissioning Forum Regional Health Authority (RHA). The method involves surgical removal of a few millimetres of bone under the acromion as well as irritated and/or inflamed tissue to make room for the tendons above the shoulder joint. The effect of the method has been debated, and there is variation in the use of the treatment option in Norway. We included four randomised trials to assess clinical efficacy and safety. In addition, we performed a cost analysis and a simplified budget impact assessment. We found that:

• There was no clinically relevant difference between subacromial decompression surgery and conservative treatment for pain, function and health-related quality of life at one year follow-up. We have medium to low confidence in the result.
• There was no difference in effect between subacromial decompression surgery and placebo surgery for pain, function and health-related quality of life at one year follow-up. We have high to medium confidence in the result.
• Complications were rare and evenly distributed between the groups. No serious complications were recorded.
• Subacromial decompression surgery is the most costly treatment alternative at about 37,000 Norwegian krone (NOK). Conservative treatment with physiotherapy alone and injections cost respectively about 13,600 and 13,200 NOK.

There is a substantial potential for cost savings in the treatment of patients with pure subacromial shoulder impingement. Potential cost savings per health region depends on the reduction in number of procedures. This is estimated to: Northern Norway between 4.8 and 8.5m, Central Norway between 8.8 and 15.1m, Western Norway between 10.5 and 18.7m and South-Eastern Norway between 0 and 9.6m NOK. At the national level, the potiential savings are between 24.1 and 51.9m NOK.