Oulu University Hospital and MRC Oulu, Surgery, Kajaanintie 50, 90029 Oulu, Finland.
Oulu University Hospital and MRC Oulu, Surgery, Kajaanintie 50, 90029 Oulu, Finland.
Orthop Traumatol Surg Res. 2024 Sep;110(5):103852. doi: 10.1016/j.otsr.2024.103852. Epub 2024 Feb 28.
This study aimed to assess cost-effectiveness of shoulder arthroplasty for osteoarthritis (OA) and rotator cuff tear arthropathy (CTA) from the perspective of a publicly funded health care system using patient data, health utilities and costs from a real-world situation.
Our hypothesis was that arthroplasty for OA is more cost-effective than for CTA.
We gathered a cohort of patients with 153 anatomic total shoulder arthroplasty (TSA) for OA and 107 reverse shoulder arthroplasty (RSA) for CTA between years 2016-2020 at a university hospital. Short-term (mean 2.8years) shoulder function, health utilities and costs were obtained from prospectively collected data, and a Markov cohort simulation was carried out to assess lifetime cost-utility. The primary outcome measures were change in 15D score to calculate gain in quality-adjusted life years (QALYs) and change in Western Ontario osteoarthritis score of the shoulder (WOOS).
Both TSA and RSA restored shoulder function well, WOOS improvement was 59.7 (95% CI: 56.2-63.2) and 55.8 (95% CI: 50.4-61.2), respectively. The cost/QALY gained was 20,846.82 € for TSA and 38,711.90 € for RSA. The cost-utility was not remarkable sensitive to costs, discounting of future costs or estimated revision rates. However, the cost-effectiveness was very sensitive to change in 15D health utility scores and thus QALY gain, especially for RSA patients.
Shoulder arthroplasty restores shoulder function well in both OA and CTA. In health economic terms, RSA is less cost-effective than TSA in an everyday setting, mainly due to inferior improvement of health-related quality-of-life and reduced life expectancy of CTA patients.
III; case series.
本研究旨在从公共资助的医疗保健系统的角度，使用患者数据、健康效用和实际情况的成本，评估肩关节炎（OA）和肩袖撕裂性关节炎（CTA）的关节置换术的成本效益。
我们的假设是，OA 的关节置换术比 CTA 更具成本效益。
我们收集了一家大学医院 2016-2020 年间进行的 153 例解剖型全肩关节置换术（TSA）治疗 OA 和 107 例反向肩关节置换术（RSA）治疗 CTA 的患者队列。从前瞻性收集的数据中获得短期（平均 2.8 年）肩部功能、健康效用和成本，并进行了马尔可夫队列模拟以评估终生成本效益。主要的结果测量是 15D 评分的变化，以计算质量调整生命年（QALYs）的增益和肩关节炎的西部安大略省评分（WOOS）的变化。
TSA 和 RSA 都很好地恢复了肩部功能，WOOS 改善分别为 59.7（95%置信区间：56.2-63.2）和 55.8（95%置信区间：50.4-61.2）。TSA 的成本/QALY 增益为 20,846.82 欧元，RSA 为 38,711.90 欧元。成本效益对成本、未来成本的折扣或估计的翻修率不太敏感。然而，成本效益对 15D 健康效用评分的变化非常敏感，因此 QALY 增益，尤其是 RSA 患者。
肩关节炎置换术在 OA 和 CTA 中均能很好地恢复肩部功能。从健康经济学的角度来看，RSA 在日常环境中的成本效益不如 TSA，主要是由于 CTA 患者的健康相关生活质量改善较差和预期寿命缩短。
III；病例系列。
