Division of Orthopedics, The Ottawa Hospital, Ottawa, Ontario, Canada.
Division of Orthopedic Surgery, University of Ottawa, Ottawa, Ontario, Canada.
J Bone Joint Surg Am. 2021 Aug 18;103(16):1499-1509. doi: 10.2106/JBJS.20.00678.
Although outcome studies generally demonstrate the superiority of a total shoulder arthroplasty (TSA) over a hemiarthroplasty (HA), comparative cost-effectiveness has not been well studied. From a publicly funded health-care system's perspective, this study compared the costs and quality-adjusted life-years (QALYs) in patients who underwent TSA with those in patients who underwent HA.
We conducted a cost-utility analysis using a Markov model to simulate the costs and QALYs for patients undergoing either TSA or HA over a lifetime horizon to account for costs and medically important events over the patient lifetime. Subgroup analyses by age groups (≤50 or >50 years) were performed. A series of sensitivity analyses were performed to assess robustness of study findings. The results were presented in 2019 U.S. dollars.
TSA was dominant as it was less costly ($115,785 compared with $118,501) and more effective (10.21 compared with 8.47 QALYs) than HA over a lifetime horizon. Changes to health utility values after TSA and HA had the largest impact on the cost-effectiveness findings. At a willingness-to-pay (WTP) threshold of $50,000 per QALY gained, HA was not found to be cost-effective. The probability that TSA was cost-effective was 100%.
Based on a WTP of $50,000 per QALY gained, from the perspective of Canada's publicly funded health-care system, TSA was found to be cost-effective in all patients, including those ≤50 years of age, compared with HA.
Economic and Decision Analysis Level II. See Instructions for Authors for a complete description of levels of evidence.
尽管总体研究结果表明全肩关节置换术（TSA）优于人工肱骨头置换术（HA），但比较其成本效益的研究却并不充分。本研究从公共资助的医疗保健体系的角度出发，比较了接受 TSA 和 HA 的患者的成本和质量调整生命年（QALY）。
我们使用马尔可夫模型进行了成本效用分析，以模拟患者在一生中接受 TSA 或 HA 的成本和 QALY，以考虑患者一生中的成本和重要的医疗事件。进行了年龄组（≤50 岁或>50 岁）的亚组分析。进行了一系列敏感性分析，以评估研究结果的稳健性。结果以 2019 年美元表示。
TSA 具有成本效益，因为它的成本较低（115785 美元比 118501 美元）且效果更好（10.21 比 8.47 QALY），因此在一生中它比 HA 更具优势。TSA 和 HA 后的健康效用值变化对成本效益发现的影响最大。在愿意支付（WTP）阈值为每获得一个 QALY 50000 美元时，HA 被认为不具有成本效益。TSA 具有成本效益的概率为 100%。
基于 WTP 为每获得一个 QALY 50000 美元，从加拿大公共资助的医疗保健体系的角度来看，在所有患者中，包括≤50 岁的患者，TSA 都被认为比 HA 更具成本效益。
经济和决策分析 II 级。有关证据水平的完整描述，请参见作者说明。
