Cost-effectiveness of total shoulder arthroplasty compared with hemiarthroplasty: a study using data from the National Joint Registry
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...
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BMJ Publishing Group
2025-03-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/15/3/e086150.full |
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| author | Andrew Davies Amar Rangan Martinique Vella-Baldacchino Alexander D Liddle Sanjeeve Sabharwal Peter Reilly Bernarda Zamora-Talaya |
| author_facet | Andrew Davies Amar Rangan Martinique Vella-Baldacchino Alexander D Liddle Sanjeeve Sabharwal Peter Reilly Bernarda Zamora-Talaya |
| author_sort | Andrew Davies |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-68e12974f52f4905bb4a2e2d4bc804a1 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-68e12974f52f4905bb4a2e2d4bc804a12025-08-20T03:40:25ZengBMJ Publishing GroupBMJ Open2044-60552025-03-0115310.1136/bmjopen-2024-086150Cost-effectiveness of total shoulder arthroplasty compared with hemiarthroplasty: a study using data from the National Joint RegistryAndrew Davies0Amar Rangan1Martinique Vella-Baldacchino2Alexander D Liddle3Sanjeeve Sabharwal4Peter Reilly5Bernarda Zamora-Talaya61 Bioengineering, Imperial College London, London, UKDepartment of Health Sciences, University of York, York, UKOxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, UKNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK1 MSk Lab, Imperial College London, London, UKDepartment of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, London, UK2 NIHR London IVD Cooperative, Imperial College London, London, UKObjectives 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.https://bmjopen.bmj.com/content/15/3/e086150.full |
| spellingShingle | Andrew Davies Amar Rangan Martinique Vella-Baldacchino Alexander D Liddle Sanjeeve Sabharwal Peter Reilly Bernarda Zamora-Talaya Cost-effectiveness of total shoulder arthroplasty compared with hemiarthroplasty: a study using data from the National Joint Registry BMJ Open |
| title | Cost-effectiveness of total shoulder arthroplasty compared with hemiarthroplasty: a study using data from the National Joint Registry |
| title_full | Cost-effectiveness of total shoulder arthroplasty compared with hemiarthroplasty: a study using data from the National Joint Registry |
| title_fullStr | Cost-effectiveness of total shoulder arthroplasty compared with hemiarthroplasty: a study using data from the National Joint Registry |
| title_full_unstemmed | Cost-effectiveness of total shoulder arthroplasty compared with hemiarthroplasty: a study using data from the National Joint Registry |
| title_short | Cost-effectiveness of total shoulder arthroplasty compared with hemiarthroplasty: a study using data from the National Joint Registry |
| title_sort | cost effectiveness of total shoulder arthroplasty compared with hemiarthroplasty a study using data from the national joint registry |
| url | https://bmjopen.bmj.com/content/15/3/e086150.full |
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