Cost-effectiveness of total shoulder arthroplasty compared to hemiarthroplasty. A study using data from the National Joint Registry
File(s)
Published version
Author(s)
Davies, Andrew
Sabharwal, Sanjeeve
Zamora Talaya, Bernarda
Liddle, Alexander
Vella-Baldacchino, Martinique
Type
Journal Article
Abstract
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.
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.
Date Issued
2025-03-01
Date Acceptance
2025-02-11
Citation
BMJ Open, 2025, 15 (3)
ISSN
2044-6055
Publisher
BMJ Publishing Group
Journal / Book Title
BMJ Open
Volume
15
Issue
3
Copyright Statement
© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
License URL
Identifier
10.1136/bmjopen-2024-086150
Publication Status
Published
Article Number
e086150
Date Publish Online
2025-03-18