title: 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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Division of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Georg
authors.initials: G
authors.lastname: Osterhoff
authors.affiliation: Department of Orthopaedics, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Nathan N
authors.initials: NN
authors.lastname: O'Hara
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: D'Cruz
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Sheila A
authors.initials: SA
authors.lastname: Sprague
authors.affiliation: Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Nick
authors.initials: N
authors.lastname: Bansback
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Nathan
authors.initials: N
authors.lastname: Evaniew
authors.affiliation: Department of Orthopaedics, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: gslobogean@umoa.umm.edu.
authors.forename: Gerard P
authors.initials: GP
authors.lastname: Slobogean
mesh_terms: D000368:Aged; D000072228:Arthroplasty, Replacement, Shoulder / Q000191:economics*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D017048:Health Care Costs; D062785:Hemiarthroplasty / Q000191:economics*; D017721:Hospital Costs; D006801:Humans; D008390:Markov Chains; D009864:Ontario; D019057:Quality-Adjusted Life Years; D012784:Shoulder Fractures / Q000191:economics / Q000601:surgery*; D016896:Treatment Outcome
keywords: cost-effectiveness; cost-utility; elderly; hemiarthroplasty; proximal humerus fracture; reverse total shoulder arthroplasty