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

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.