ABSTRACT Objective The purpose of this study was to evaluate the clinical and functional outcomes in patients who underwent surgical treatment for rotator cuff tears using open and arthroscopic techniques, and to evaluate the direct costs involved. Methods Retrospective cohort study with analysis of the data of patients who were referred to two private hospitals in Sao Paulo, Brazil for surgical repair of the rotator cuff from January 2018 to September 2019. Clinical outcomes were assessed using functional scores (SPADI and QuickDASH) and a quality of life questionnaire (EuroQoL). Procedure costs were calculated relative to each hospital’s costliest procedure. Results Data from 362 patients were analyzed. The mean patient age was 57 years (SD= 10.46), with a slight male predominance (53.9%). Arthroscopic procedures were more common than open procedures (95.6% versus 4.4%). Significant clinical improvement was reported in 84.8% of the patients. The factors associated with increased surgery costs were arthroscopic technique (increase of 29.2%), age (increase of 0.6% per year), and length of stay (increase of 18.9% per day of hospitalization). Conclusion Rotator cuff repair surgery is a highly effective procedure, associated with favorable clinical outcomes and improvement in life quality, and low rates of complications. Arthroscopic surgery tends to be costlier than open surgery. techniques involved Paulo 201 2019 SPADI QuickDASH EuroQoL. EuroQoL . (EuroQoL) hospital s procedure 36 analyzed 5 SD= SD (SD 10.46, 1046 10.46 , 10 46 10.46) 53.9%. 539 53.9% 53 9 (53.9%) 95.6% 956 95 6 (95.6 4.4%. 44 4.4% 4 4.4%) 848 84 8 84.8 increase 29.2%, 292 29.2% 29 2 29.2%) 06 0 0.6 year, year year) 189 18 18.9 hospitalization. hospitalization hospitalization) complications 20 (EuroQoL 3 104 10.4 1 53.9 (53.9% 95.6 (95. 4.4 84. 29.2 0. 18. 10. 53. (53.9 95. (95 4. 29. (53. (9 (53 ( (5