Cost-utility analysis of total shoulder arthroplasty: a prospective health economic study using real-world data

BackgroundWith increasing health care expenditures, knowledge about the benefit and costs of surgical interventions such as total shoulder arthroplasty (TSA) becomes important for orthopedic surgeons, social insurance programs, policy decision makers. We examined impact TSA on quality life (QOL), direct medical costs, productivity losses evaluated cost-utility ratio compared with ongoing nonoperative management using real-world data.MethodsPatients osteoarthritis and/or rotator cuff tear arthropathy indicated anatomic or reverse were included in this prospective study. QOL (European Quality Life 5 Dimensions 5-Level questionnaire) function (Constant score; Shoulder Pain Disability Index; short version Disabilities Arm, Hand questionnaire; Subjective Value) assessed preoperatively up to 2 years postoperatively. Health companies provided all-diagnosis 2018 Swiss francs (CHF), where 1 CHF was equivalent US $1.02. Indirect Work Productivity Activity Impairment Questionnaire. Baseline data at recruitment preoperative year served a proxy management. The incremental cost-effectiveness (ICER) calculated gain extra quality-adjusted life-year (QALY) based both system perspective societal perspective. relationship between by regression analysis.ResultsThe mean utility index European questionnaire 0.68 150 patients (mean age, 71 years; 21% working; 58% women) increased 0.89 0.87 postoperatively, respectively. Mean 11,771 (preoperatively), 34,176 (1 postoperatively), 11,763 (2 postoperatively). ICER 63,299 CHF/QALY (95% confidence interval, 44,391-82,206 CHF/QALY). 29 working decreased from 40,574 per patient (preoperatively) 26,114 postoperatively 10,310 When considering these losses, 35,549 12,076-59,016 significantly associated (P < .001).ConclusionUsing cost data, we Switzerland, which clearly falls below often-suggested 100,000-CHF/QALY threshold acceptable cost-effectiveness. In view highly cost-effective an 35,546 CHF/QALY. With data. Patients analysis. .001). Using