title: Cost utility analysis of reverse total shoulder arthroplasty.
abstract: 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.
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  Level II, economic and decision analysis.
authors.affiliation: Department of Orthopedics, Mayo Clinic Hospital, Phoenix, AZ, USA; Division of Plastic and Reconstructive Surgery, Mayo Clinic Hospital, Phoenix, AZ, USA. Electronic address: renfree.kevin@mayo.edu.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Renfree
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Hattrup
authors.forename: Yu-Hui H
authors.initials: YH
authors.lastname: Chang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D012421:Rupture; D012785:Shoulder Joint / Q000601:surgery*; D013708:Tendon Injuries / Q000601:surgery*; D016896:Treatment Outcome
keywords: Cost-effectiveness; Economic and Decision Analysis; Level II; cost utility; quality-adjusted life-years; reverse shoulder arthroplasty