Division of Orthopaedic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
J Shoulder Elbow Surg. 2010 Apr;19(3):325-34. doi: 10.1016/j.jse.2009.11.057.
Total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) are two viable surgical treatment options for glenohumeral osteoarthritis. Recent systematic reviews and randomized trials suggest that TSA, while more costly initially, may have superior outcomes with regard to pain, function and quality of life with lower revision rates. This study compared the cost-effectiveness of TSA with HA.
A Markov decision model was constructed for a cost-utility analysis of TSA compared to HA in a cohort of 64-year-old patients. Outcome probabilities and effectiveness were derived from the literature. Costs were estimated from the societal perspective using the national average Medicare reimbursement for the procedures in 2008 US dollars. Effectiveness was expressed in quality-adjusted life years (QALYs) gained. Principal outcome measures were average incremental costs, incremental effectiveness, incremental QALYs, and net health benefits.
In the base case, HA resulted in a lower number of average QALYs gained at a higher average cost to society and was, therefore, dominated by the TSA strategy for the treatment of glenohumeral osteoarthritis. The cost effectiveness ratio for TSA and HA were $957/QALY and $1,194/QALY respectively. Sensitivity analysis revealed that if the utility of TSA is equal to, or revision rate lower than HA, TSA continues to be a dominant strategy.
Total shoulder arthroplasty with a cemented glenoid is a cost-effective procedure, resulting in greater utility for the patient at a lower overall cost to the payer. These findings suggest that TSA is the preferred treatment for certain populations from both a patient and payer perspective.
全肩关节置换术（TSA）和人工肱骨头置换术（HA）是治疗肩肱关节炎的两种可行的手术治疗选择。最近的系统评价和随机试验表明，TSA 虽然初始成本较高，但在疼痛、功能和生活质量方面可能具有更好的结果，并且翻修率较低。本研究比较了 TSA 与 HA 的成本效益。
为 64 岁患者的 TSA 与 HA 进行成本效益分析，构建了一个马尔可夫决策模型。从文献中得出结果概率和效果。从社会角度，使用 2008 年美国全国平均医疗保险报销额，对程序成本进行了估计。效果用获得的质量调整生命年（QALY）表示。主要结果指标为平均增量成本、增量效果、增量 QALY 和净健康收益。
在基本情况下，HA 在获得较少的平均 QALY 的情况下，对社会的平均成本更高，因此被 TSA 策略所主导，用于治疗肩肱关节炎。TSA 和 HA 的成本效益比分别为 957 美元/QALY 和 1194 美元/QALY。敏感性分析表明，如果 TSA 的效用等于或低于 HA，则 TSA 继续成为主导策略。
使用骨水泥固定的全肩关节置换术是一种具有成本效益的手术，可为患者提供更高的效用，同时降低支付者的总成本。这些发现表明，从患者和支付者的角度来看，TSA 是某些人群的首选治疗方法。
