A recent study revealed that total shoulder arthroplasty may be more cost-effective compared with hemiarthroplasty among patients with osteoarthritis and an intact rotator cuff.
In the study, published in BMJ Open, investigators utilized data from the National Joint Registry and employed a lifetime cohort Markov model to assess the cost-effectiveness across different age and gender subgroups.
They found that total shoulder arthroplasty (TSA) was more cost-effective in all analyzed subgroups, with a probability of approximately 70% for TSA being cost-effective compared with hemiarthroplasty (HA) at any willingness-to-pay threshold above £1,100 per quality-adjusted life-year (QALY). Specifically, in younger patients (aged 60 years and younger), TSA demonstrated a mean cost saving of £463 ($570) in male and £658 ($810) in female patients, alongside a mean QALY gain of 2.0 in both sexes.
In the cohort aged 61 to 75 years, HA resulted in a mean cost saving of £395 ($490) in male and £181 ($220) in female patients, whereas TSA still provided superior QALY gains of 1.3 in male and 1.4 in female patients. Among patients over 75 years, HA was less costly, with savings of £905 ($1,120) in male and £966 ($1,200) in female patients; however, TSA still yielded higher QALY gains of 0.7 in male and 0.9 in female patients.
“TSA was dominant in patients 60 years and younger at a willingness to pay threshold of £0, primarily due to the large difference in revision rate and longer lifetime of patients in this subgroup, implying TSA is cost saving compared with HA,” said lead study author Andrew Davies, of the Department of Bioengineering at Imperial College London, and his colleagues.
The analysis was informed by propensity score-matched comparisons of TSA and HA, focusing on patients with osteoarthritis and an intact rotator cuff. The study population included 14,698 anatomical shoulder arthroplasties, with a mean age of 70.1 years, comprising 31.7% male patients and 68.3% female patients.
The investigators acknowledged that while TSA implants were more expensive and involved longer surgical durations, the initial cost difference may have had limited impact over the patients' lifetimes.
The study's probabilistic sensitivity analysis further supported the robustness of the findings, indicating that TSA consistently outperformed HA in terms of cost-effectiveness.
The investigators established that TSA may be more cost-effective compared with HA in managing glenohumeral osteoarthritis, with superior QALYs across all patient groups. They emphasized the importance of considering age and sex when evaluating the cost-effectiveness of shoulder arthroplasties.
The authors reported no conflicts of interest.
