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Updated: May 21, 2025
Reverse Total Shoulder Arthroplasty
Published on: July 5, 2011
Cost-effectiveness of total shoulder arthroplasty compared with hemiarthroplasty: a study using data from the
Andrew Davies1, Bernarda Zamora-Talaya2, Sanjeeve Sabharwal3
1Bioengineering, Imperial College London, London, UK a.davies20@imperial.ac.uk.
Objectives:
The aim of this study was to compare the cost-effectiveness of total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) and explore variation by age and gender.
Design:
Cost-effectiveness analysis using a lifetime cohort Markov model.
Setting:
National population registry data.
Participants:
Model parameters were informed by propensity score-matched comparisons of TSA and HA in patients with osteoarthritis and an intact rotator cuff using data from the National Joint Registry.
Interventions:
TSA and HA.
Primary Outcome Measures:
Quality-adjusted life years (QALYs) and healthcare costs for age and gender subgroups. A probabilistic sensitivity analysis was performed.
Results:
In all subgroups, TSA was more cost-effective, with the probability of being cost-effective about 70% for TSA versus 30% for HA at any willingness-to-pay threshold above £1100 per QALY. TSA was dominant in young patients (≤60 years) with a mean cost saving of £463 in men and £658 in women, and a mean QALY gain of 2 in both men and women. In patients aged 61-75 years, there was a mean cost saving following HA of £395 in men and £181 in women, while QALYs remained superior following TSA with a 1.3 gain in men and 1.4 in women. In the older cohort (> 75 years), the cost difference was highest and the QALY difference was lowest; there was a cost-saving following HA of £905 in men and £966 in women. The mean QALY gain remained larger after TSA: 0.7 in men and 0.9 in women.
Conclusion:
TSA was more cost-effective than HA in patients with osteoarthritis. QALYs were superior following TSA in all patient groups. Cost differences varied by age and TSA was dominant in young patients.
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