Journal Article

Cost-effectiveness of total shoulder arthroplasty compared with hemiarthroplasty: a study using data from the National Joint Registry

Vella-Baldacchino, Martinique, Zamora-Talaya, Bernarda, Davies, Andrew, Sabharwal, Sanjeeve, Liddle, Alexander D, Rangan, Amar, Reilly, Peter

2025

Overview

ObjectivesThe 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.DesignCost-effectiveness analysis using a lifetime cohort Markov model.SettingNational population registry data.ParticipantsModel 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.InterventionsTSA and HA.Primary outcome measuresQuality-adjusted life years (QALYs) and healthcare costs for age and gender subgroups. A probabilistic sensitivity analysis was performed.ResultsIn 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.ConclusionTSA 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.

• Publisher: British Medical Journal Publishing Group,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Age Factors / Age groups / Aged / Aged, 80 and over / Arthroplasty, Replacement, Shoulder - economics / Arthroplasty, Replacement, Shoulder - methods / Cost analysis / Cost estimates / Cost-Benefit Analysis / Elbow & shoulder / Female / Gender / Health Care Costs / Health economics / Hemiarthroplasty - economics / Hospital costs / Humans / Joint replacement surgery / Male / Markov Chains / Medical personnel / Middle Aged / Mortality / ORTHOPAEDIC & TRAUMA SURGERY / Osteoarthritis - economics / Osteoarthritis - surgery / Patients / Prostheses / Quality of life / Quality-Adjusted Life Years / Registries / Rotator cuff / Shoulder / Surgery / Transplants & implants / United Kingdom