A Cost-Effectiveness Analysis of Reverse Total Shoulder Arthroplasty versus Hemiarthroplasty for the Management of Complex Proximal Humeral Fractures in the Elderly
Abstract 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...
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| Veröffentlicht in: | Value in health 2017-03, Vol.20 (3), p.404-411 |
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| creator | Osterhoff, Georg, MD O’Hara, Nathan N., MHA D’Cruz, Jennifer, MSc Sprague, Sheila A., PhD Bansback, Nick, PhD Evaniew, Nathan, MD Slobogean, Gerard P., MD, MPH |
| description | Abstract 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. |
| doi_str_mv | 10.1016/j.jval.2016.10.017 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1877851653</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S1098301516340700</els_id><sourcerecordid>1877851653</sourcerecordid><originalsourceid>FETCH-LOGICAL-c483t-73289551d36973a3830fe8205efe880d3f403c922672f4d0768dcdcff88c38913</originalsourceid><addsrcrecordid>eNp9ks9u1DAQxiMEoqXwAhyQJS5csvhfEkdCSKvVlkUqAtFytowzpl6ceOtJVt334UFx2FKhHjiNNfp9nzXzTVG8ZHTBKKvfbhfbvQkLnt-5saCseVScsorLUjZCPM5v2qpSUFadFM8Qt5TSWvDqaXHCFW-5VNVp8WtJVhHHcu0c2NHvYQBEshxMOKBHEh35CntICOQqjiaQy-s4hQ4SWabxOsVdMDgeyExMSDbQe_Nv38VExmsgn8xgfkAPwzg7rmK_C3BLvqR46_tsupl6SLmeJ2PHKQESP_zRreevwuF58cSZgPDirp4V387XV6tNefH5w8fV8qK0UomxbARXbVWxTtRtI4xQgjpQnFaQi6KdcJIK23JeN9zJjja16mxnnVPKCtUycVa8OfruUryZAEfde7QQghkgTqiZahpVsboSGX39AN3GKeW1oeZUSVlTWclM8SNlU0RM4PQu5YnTQTOq5wz1Vs8Z6jnDuZczzKJXd9bT9x66e8nf0DLw7ghA3sXeQ9JoPQwWOp9yiLqL_v_-7x_IbfCDtyb8hAPg_RxMI9dUX85XNB8Rq4WkDaXiN-Mgw_c</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2084460454</pqid></control><display><type>article</type><title>A Cost-Effectiveness Analysis of Reverse Total Shoulder Arthroplasty versus Hemiarthroplasty for the Management of Complex Proximal Humeral Fractures in the Elderly</title><source>Applied Social Sciences Index & Abstracts (ASSIA)</source><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Osterhoff, Georg, MD ; O’Hara, Nathan N., MHA ; D’Cruz, Jennifer, MSc ; Sprague, Sheila A., PhD ; Bansback, Nick, PhD ; Evaniew, Nathan, MD ; Slobogean, Gerard P., MD, MPH</creator><creatorcontrib>Osterhoff, Georg, MD ; O’Hara, Nathan N., MHA ; D’Cruz, Jennifer, MSc ; Sprague, Sheila A., PhD ; Bansback, Nick, PhD ; Evaniew, Nathan, MD ; Slobogean, Gerard P., MD, MPH</creatorcontrib><description>Abstract 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.</description><identifier>ISSN: 1098-3015</identifier><identifier>EISSN: 1524-4733</identifier><identifier>DOI: 10.1016/j.jval.2016.10.017</identifier><identifier>PMID: 28292485</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Arthritis ; Arthroplasty ; Arthroplasty, Replacement, Shoulder - economics ; Cost analysis ; Cost-Benefit Analysis ; cost-effectiveness ; cost-utility ; Decision Trees ; Economic analysis ; elderly ; Fractures ; Geriatrics ; Health Care Costs ; hemiarthroplasty ; Hemiarthroplasty - economics ; Hip ; Hospital Costs ; Humans ; Humerus ; Internal Medicine ; Markov Chains ; Older people ; Ontario ; proximal humerus fracture ; Quality-Adjusted Life Years ; reverse total shoulder arthroplasty ; Sensitivity analysis ; Shoulder ; Shoulder Fractures - economics ; Shoulder Fractures - surgery ; Thresholds ; Total hip arthroplasty ; Treatment Outcome ; Utility functions ; Willingness to pay</subject><ispartof>Value in health, 2017-03, Vol.20 (3), p.404-411</ispartof><rights>International Society for Pharmacoeconomics and Outcomes Research (ISPOR)</rights><rights>2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR)</rights><rights>Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Science Ltd. Mar 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c483t-73289551d36973a3830fe8205efe880d3f403c922672f4d0768dcdcff88c38913</citedby><cites>FETCH-LOGICAL-c483t-73289551d36973a3830fe8205efe880d3f403c922672f4d0768dcdcff88c38913</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1098301516340700$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,30976,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28292485$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Osterhoff, Georg, MD</creatorcontrib><creatorcontrib>O’Hara, Nathan N., MHA</creatorcontrib><creatorcontrib>D’Cruz, Jennifer, MSc</creatorcontrib><creatorcontrib>Sprague, Sheila A., PhD</creatorcontrib><creatorcontrib>Bansback, Nick, PhD</creatorcontrib><creatorcontrib>Evaniew, Nathan, MD</creatorcontrib><creatorcontrib>Slobogean, Gerard P., MD, MPH</creatorcontrib><title>A Cost-Effectiveness Analysis of Reverse Total Shoulder Arthroplasty versus Hemiarthroplasty for the Management of Complex Proximal Humeral Fractures in the Elderly</title><title>Value in health</title><addtitle>Value Health</addtitle><description>Abstract 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.</description><subject>Aged</subject><subject>Arthritis</subject><subject>Arthroplasty</subject><subject>Arthroplasty, Replacement, Shoulder - economics</subject><subject>Cost analysis</subject><subject>Cost-Benefit Analysis</subject><subject>cost-effectiveness</subject><subject>cost-utility</subject><subject>Decision Trees</subject><subject>Economic analysis</subject><subject>elderly</subject><subject>Fractures</subject><subject>Geriatrics</subject><subject>Health Care Costs</subject><subject>hemiarthroplasty</subject><subject>Hemiarthroplasty - economics</subject><subject>Hip</subject><subject>Hospital Costs</subject><subject>Humans</subject><subject>Humerus</subject><subject>Internal Medicine</subject><subject>Markov Chains</subject><subject>Older people</subject><subject>Ontario</subject><subject>proximal humerus fracture</subject><subject>Quality-Adjusted Life Years</subject><subject>reverse total shoulder arthroplasty</subject><subject>Sensitivity analysis</subject><subject>Shoulder</subject><subject>Shoulder Fractures - economics</subject><subject>Shoulder Fractures - surgery</subject><subject>Thresholds</subject><subject>Total hip arthroplasty</subject><subject>Treatment Outcome</subject><subject>Utility functions</subject><subject>Willingness to pay</subject><issn>1098-3015</issn><issn>1524-4733</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><recordid>eNp9ks9u1DAQxiMEoqXwAhyQJS5csvhfEkdCSKvVlkUqAtFytowzpl6ceOtJVt334UFx2FKhHjiNNfp9nzXzTVG8ZHTBKKvfbhfbvQkLnt-5saCseVScsorLUjZCPM5v2qpSUFadFM8Qt5TSWvDqaXHCFW-5VNVp8WtJVhHHcu0c2NHvYQBEshxMOKBHEh35CntICOQqjiaQy-s4hQ4SWabxOsVdMDgeyExMSDbQe_Nv38VExmsgn8xgfkAPwzg7rmK_C3BLvqR46_tsupl6SLmeJ2PHKQESP_zRreevwuF58cSZgPDirp4V387XV6tNefH5w8fV8qK0UomxbARXbVWxTtRtI4xQgjpQnFaQi6KdcJIK23JeN9zJjja16mxnnVPKCtUycVa8OfruUryZAEfde7QQghkgTqiZahpVsboSGX39AN3GKeW1oeZUSVlTWclM8SNlU0RM4PQu5YnTQTOq5wz1Vs8Z6jnDuZczzKJXd9bT9x66e8nf0DLw7ghA3sXeQ9JoPQwWOp9yiLqL_v_-7x_IbfCDtyb8hAPg_RxMI9dUX85XNB8Rq4WkDaXiN-Mgw_c</recordid><startdate>20170301</startdate><enddate>20170301</enddate><creator>Osterhoff, Georg, MD</creator><creator>O’Hara, Nathan N., MHA</creator><creator>D’Cruz, Jennifer, MSc</creator><creator>Sprague, Sheila A., PhD</creator><creator>Bansback, Nick, PhD</creator><creator>Evaniew, Nathan, MD</creator><creator>Slobogean, Gerard P., MD, MPH</creator><general>Elsevier Inc</general><general>Elsevier Science Ltd</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>7X8</scope></search><sort><creationdate>20170301</creationdate><title>A Cost-Effectiveness Analysis of Reverse Total Shoulder Arthroplasty versus Hemiarthroplasty for the Management of Complex Proximal Humeral Fractures in the Elderly</title><author>Osterhoff, Georg, MD ; O’Hara, Nathan N., MHA ; D’Cruz, Jennifer, MSc ; Sprague, Sheila A., PhD ; Bansback, Nick, PhD ; Evaniew, Nathan, MD ; Slobogean, Gerard P., MD, MPH</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c483t-73289551d36973a3830fe8205efe880d3f403c922672f4d0768dcdcff88c38913</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Arthritis</topic><topic>Arthroplasty</topic><topic>Arthroplasty, Replacement, Shoulder - economics</topic><topic>Cost analysis</topic><topic>Cost-Benefit Analysis</topic><topic>cost-effectiveness</topic><topic>cost-utility</topic><topic>Decision Trees</topic><topic>Economic analysis</topic><topic>elderly</topic><topic>Fractures</topic><topic>Geriatrics</topic><topic>Health Care Costs</topic><topic>hemiarthroplasty</topic><topic>Hemiarthroplasty - economics</topic><topic>Hip</topic><topic>Hospital Costs</topic><topic>Humans</topic><topic>Humerus</topic><topic>Internal Medicine</topic><topic>Markov Chains</topic><topic>Older people</topic><topic>Ontario</topic><topic>proximal humerus fracture</topic><topic>Quality-Adjusted Life Years</topic><topic>reverse total shoulder arthroplasty</topic><topic>Sensitivity analysis</topic><topic>Shoulder</topic><topic>Shoulder Fractures - economics</topic><topic>Shoulder Fractures - surgery</topic><topic>Thresholds</topic><topic>Total hip arthroplasty</topic><topic>Treatment Outcome</topic><topic>Utility functions</topic><topic>Willingness to pay</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Osterhoff, Georg, MD</creatorcontrib><creatorcontrib>O’Hara, Nathan N., MHA</creatorcontrib><creatorcontrib>D’Cruz, Jennifer, MSc</creatorcontrib><creatorcontrib>Sprague, Sheila A., PhD</creatorcontrib><creatorcontrib>Bansback, Nick, PhD</creatorcontrib><creatorcontrib>Evaniew, Nathan, MD</creatorcontrib><creatorcontrib>Slobogean, Gerard P., MD, MPH</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>MEDLINE - Academic</collection><jtitle>Value in health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Osterhoff, Georg, MD</au><au>O’Hara, Nathan N., MHA</au><au>D’Cruz, Jennifer, MSc</au><au>Sprague, Sheila A., PhD</au><au>Bansback, Nick, PhD</au><au>Evaniew, Nathan, MD</au><au>Slobogean, Gerard P., MD, MPH</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Cost-Effectiveness Analysis of Reverse Total Shoulder Arthroplasty versus Hemiarthroplasty for the Management of Complex Proximal Humeral Fractures in the Elderly</atitle><jtitle>Value in health</jtitle><addtitle>Value Health</addtitle><date>2017-03-01</date><risdate>2017</risdate><volume>20</volume><issue>3</issue><spage>404</spage><epage>411</epage><pages>404-411</pages><issn>1098-3015</issn><eissn>1524-4733</eissn><abstract>Abstract 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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28292485</pmid><doi>10.1016/j.jval.2016.10.017</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Arthritis Arthroplasty Arthroplasty, Replacement, Shoulder - economics Cost analysis Cost-Benefit Analysis cost-effectiveness cost-utility Decision Trees Economic analysis elderly Fractures Geriatrics Health Care Costs hemiarthroplasty Hemiarthroplasty - economics Hip Hospital Costs Humans Humerus Internal Medicine Markov Chains Older people Ontario proximal humerus fracture Quality-Adjusted Life Years reverse total shoulder arthroplasty Sensitivity analysis Shoulder Shoulder Fractures - economics Shoulder Fractures - surgery Thresholds Total hip arthroplasty Treatment Outcome Utility functions Willingness to pay |
| title | A Cost-Effectiveness Analysis of Reverse Total Shoulder Arthroplasty versus Hemiarthroplasty for the Management of Complex Proximal Humeral Fractures in the Elderly |
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