Prospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Feb 18, 2016; 7(2): 123-127
Published online Feb 18, 2016. doi: 10.5312/wjo.v7.i2.123
Reverse-total shoulder arthroplasty cost-effectiveness: A quality-adjusted life years comparison with total hip arthroplasty
Daniel Bachman, John Nyland, Ryan Krupp
Daniel Bachman, John Nyland, Ryan Krupp, Department of Orthopaedic Surgery, University of Louisville, Louisville, KY 40202, United States
John Nyland, Athletic Training Program, Kosair Charities College of Health and Natural Sciences, Spalding University, Louisville, KY 40203, United States
Ryan Krupp, Norton Orthopaedic and Sports, Louisville, KY 40241, United States
Author contributions: Bachman D drafted the manuscript and performed data analysis; Nyland J participated in study design and edited the manuscript; Krupp R provided oversight to manuscript development, recruited patients, and collected data; all authors read and approved the final manuscript.
Institutional review board statement: This study was approved by the University of Louisville and Norton Healthcare Medical Institutional Review Boards (NHORA 12-No155).
Clinical trial registration statement: Data used in this study was obtained from clinical trial PS-901.
Informed consent statement: All study participants provided written consent prior to study enrollment.
Conflict-of-interest statement: Dr. Ryan Krupp has served as a past consultant for DJO Surgical previously receiving an honorarium for teaching and also for research support. Drs. Bachman and Nyland have no conflicts of interest to disclose.
Data sharing statement: There is no additional data available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is 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 and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: John Nyland, Director, Professor, Athletic Training Program, Kosair Charities College of Health and Natural Sciences, Spalding University, 901 South 3rd Street, Louisville, KY 40203, United States. jnyland@spalding.edu
Telephone: +1-502-8734224 Fax: +1-502-5857149
Received: July 3, 2015
Peer-review started: July 9, 2015
First decision: September 30, 2015
Revised: October 10, 2015
Accepted: December 7, 2015
Article in press: December 8, 2015
Published online: February 18, 2016
Processing time: 228 Days and 10.5 Hours
Abstract

AIM: To compare reverse-total shoulder arthroplasty (RSA) cost-effectiveness with total hip arthroplasty cost-effectiveness.

METHODS: This study used a stochastic model and decision-making algorithm to compare the cost-effectiveness of RSA and total hip arthroplasty. Fifteen patients underwent pre-operative, and 3, 6, and 12 mo post-operative clinical examinations and Short Form-36 Health Survey completion. Short form-36 Health Survey subscale scores were converted to EuroQual Group Five Dimension Health Outcome scores and compared with historical data from age-matched patients who had undergone total hip arthroplasty. Quality-adjusted life year (QALY) improvements based on life expectancies were calculated.

RESULTS: The cost/QALY was $3900 for total hip arthroplasty and $11100 for RSA. After adjusting the model to only include shoulder-specific physical function subscale items, the RSA QALY improved to 2.8 years, and its cost/QALY decreased to $8100.

CONCLUSION: Based on industry accepted standards, cost/QALY estimates supported both RSA and total hip arthroplasty cost-effectiveness. Although total hip arthroplasty remains the quality of life improvement “gold standard” among arthroplasty procedures, cost/QALY estimates identified in this study support the growing use of RSA to improve patient quality of life.

Keywords: Quality of life; Arthroplasty; Shoulder; Cost-analysis

Core tip: Based on industry accepted standards, cost/quality-adjusted life year (QALY) estimates supported both reverse-total shoulder arthroplasty (RSA) and total hip arthroplasty cost-effectiveness. The cost/QALY estimates identified in this study support the growing use of RSA to improve patient quality of life.