A Cost-Effectiveness Analysis of Reverse Total Shoulder Arthroplasty versus Hemiarthroplasty for the Management of Complex Proximal Humeral Fractures in the Elderly.
- Osterhoff G Division of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland.
- O'Hara NN Department of Orthopaedics, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.
- D'Cruz J Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
- Sprague SA Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
- Bansback N 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.
- Evaniew N Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
- Slobogean GP Department of Orthopaedics, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: gslobogean@umoa.umm.edu.
- 2017-03-16
Published in:
- Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research. - 2017
cost-effectiveness
cost-utility
elderly
hemiarthroplasty
proximal humerus fracture
reverse total shoulder arthroplasty
Aged
Arthroplasty, Replacement, Shoulder
Cost-Benefit Analysis
Decision Trees
Health Care Costs
Hemiarthroplasty
Hospital Costs
Humans
Markov Chains
Ontario
Quality-Adjusted Life Years
Shoulder Fractures
Treatment Outcome
English
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.
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.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1016/j.jval.2016.10.017
- PMID 28292485
- Persistent URL
- https://sonar.ch/global/documents/134871
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