Shoulder Arthroplasty as Cost-Effective as Hemiarthroplasty

Total shoulder arthroplasty is as cost-effective as hemiarthroplasty, according to a new study.

In the new study, “Total Shoulder Arthroplasty Is Cost-Effective Compared with Hemiarthroplasty,” published on August 18, 2021 in the Journal of Bone and Joint Surgery, the researchers conducted a cost-utility analysis between the two procedures.

“Both hemiarthroplasty and anatomic total shoulder arthroplasty are commonly used to treat pain and dysfunction in patients with glenohumeral arthritis. Over the past decades, there has been increased utilization of anatomic total shoulder arthroplasty compared with hemiarthroplasty,” the researchers wrote.

“Various factors weigh into decision-making in terms of implant selection, including treatment effectiveness in terms of improvement in pain and function, surgeon experience and training, complications and revision rates, and cost.”

They added, “Although outcome studies generally demonstrate the superiority of a total shoulder arthroplasty over a hemiarthroplasty, comparative cost-effectiveness has not been well studied. From a publicly funded health-care system’s perspective, this study compared the costs and quality-adjusted life-years in patients who underwent total shoulder arthroplasty with those in patients who underwent hemiarthroplasty.

The researchers, who are based in Canada and conducted this study based on the Canadian healthcare system, used a Markov model to simulate the costs and quality-adjusted life. Subgroup analyses by age groups were also performed, either 50 or older or younger than 50. They also performed a series of sensitivity analyses.

Total shoulder arthroplasty was both less costly ($115,785 compared with $118,501) and more effective (10.21 compared with 8.47 QALYs [quality adjusted life years]) than hemiarthroplasty over a lifetime.

Changes to health utility values after total shoulder arthroplasty and hemiarthroplasty had the largest impact on the cost-effectiveness findings. At a willingness-to-pay threshold of $50,000 per QALY gained, hemiarthroplasty wasn’t found to be cost-effective. On the other hand, the probability of total shoulder arthroplasty being cost-effective was 100%.

“Based on a Willingness to Pay of $50,000 per QALY gained, from the perspective of Canada’s publicly funded health-care system. total shoulder arthroplasty was found to be cost-effective in all patients, including those ≤50 years of age, compared with hemiarthroplasty,” the researchers concluded.