Cost utility analysis of reverse total shoulder arthroplasty
Kevin J. Renfree, MD,a,b,* Steven J. Hattrup, MD,a and Yu-Hui H. Chang, MPH, PhDcShoulder
Background
Reverse shoulder arthroplasty provides satisfactory outcomes, but its cost-effectiveness is unproven. We prospectively analyzed outcomes and costs for primary reverse shoulder arthroplasty.
Methods
Thirty serial patients (16 women and 14 men; mean age, 74.1 years [range, 61.1–87.3 years]) with rotator cuff arthropathy had active motion recorded and completed function tests (visual pain analog scale; Simple Shoulder Test; American Shoulder and Elbow Surgeons Shoulder Outcome score; EuroQol; and Short Form-36 Health Survey) preoperatively and postoperatively at 1 and 2 years. Costs included professional fees, operating room and supply costs, and hospital care. Changes were compared by the Wilcoxon signed rank test, and quality-adjusted life-years were calculated preoperatively and postoperatively.
Results
Twenty-seven patients completed the study. Clinical and functional outcomes demonstrated significant improvement (P < .05). Significantly improved (P < .05) Short Form-36 subgroups included physical functioning, role limitations due to physical health, bodily pain, vitality, and physical composite score. EuroQol dimensions of usual activities and pain/discomfort improved significantly (P <.05). Calculations with the SF-6D showed that median QALYs improved from 6.56 preoperatively to 7.43 at 1-year follow-up (P <.09) and from 6.56 preoperatively to 7.58 at 2-year follow-up (P <.003). The increase in QALYs calculated from the EQ-5D was somewhat greater, changing from 6.21 preoperatively to 7.69 at 1-year follow-up (P <.0001) and from 6.13 to 8.10 at 2-year follow-up (P <.04). Mean cost was $21,536. Cost utility at 2 years was $26,920/quality-adjusted life-year by the Short Form 6 Dimensions and $16,747/quality-adjusted life-year by the EuroQol.
Conclusion
EuroQol and Short Form-36 results demonstrated modestly cost-effective (<$50,000/quality-adjusted life-year) improvement for cuff tear arthropathy patients after primary reverse shoulder arthroplasty.
Level of evidence
Level II, Economic and Decision Analysis.
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