A Cost-Effectiveness Analysis of Reverse Total Shoulder Arthroplasty versus Hemiarthroplasty for the Management of Complex Proximal Humeral Fractures in the Elderly

Georg Osterhoff; Nathan N O'Hara; Jennifer D'Cruz; Sheila A Sprague; Nick Bansback; Nathan Evaniew; Gerard P Slobogean

doi:10.1016/j.jval.2016.10.017

A Cost-Effectiveness Analysis of Reverse Total Shoulder Arthroplasty versus Hemiarthroplasty for the Management of Complex Proximal Humeral Fractures in the Elderly

Value Health. 2017 Mar;20(3):404-411. doi: 10.1016/j.jval.2016.10.017. Epub 2016 Dec 12.

Authors

Georg Osterhoff¹, Nathan N O'Hara², Jennifer D'Cruz³, Sheila A Sprague⁴, Nick Bansback⁵, Nathan Evaniew⁶, Gerard P Slobogean⁷

Affiliations

¹ Division of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland.
² Department of Orthopaedics, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.
³ Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
⁴ Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
⁵ Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
⁶ Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
⁷ Department of Orthopaedics, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: gslobogean@umoa.umm.edu.

PMID: 28292485
DOI: 10.1016/j.jval.2016.10.017

Abstract

Background: There is ongoing debate regarding the optimal surgical treatment of complex proximal humeral fractures in elderly patients.

Objectives: To evaluate the cost-effectiveness of reverse total shoulder arthroplasty (RTSA) compared with hemiarthroplasty (HA) in the management of complex proximal humeral fractures, using a cost-utility analysis.

Methods: On the basis of data from published literature, a cost-utility analysis was conducted using decision tree and Markov modeling. A single-payer perspective, with a willingness-to-pay (WTP) threshold of Can$50,000 (Canadian dollars), and a lifetime time horizon were used. The incremental cost-effectiveness ratio (ICER) was used as the study's primary outcome measure.

Results: In comparison with HA, the incremental cost per quality-adjusted life-year gained for RTSA was Can$13,679. One-way sensitivity analysis revealed the model to be sensitive to the RTSA implant cost and the RTSA procedural cost. The ICER of Can$13,679 is well below the WTP threshold of Can$50,000, and probabilistic sensitivity analysis demonstrated that 92.6% of model simulations favored RTSA.

Conclusions: Our economic analysis found that RTSA for the treatment of complex proximal humeral fractures in the elderly is the preferred economic strategy when compared with HA. The ICER of RTSA is well below standard WTP thresholds, and its estimate of cost-effectiveness is similar to other highly successful orthopedic strategies such as total hip arthroplasty for the treatment of hip arthritis.

Keywords: cost-effectiveness; cost-utility; elderly; hemiarthroplasty; proximal humerus fracture; reverse total shoulder arthroplasty.

Publication types

Comparative Study

MeSH terms

Aged
Arthroplasty, Replacement, Shoulder / economics*
Cost-Benefit Analysis
Decision Trees
Health Care Costs
Hemiarthroplasty / economics*
Hospital Costs
Humans
Markov Chains
Ontario
Quality-Adjusted Life Years
Shoulder Fractures / economics
Shoulder Fractures / surgery*
Treatment Outcome