Monday, October 21, 2013

Reverse total shoulder - cost utility analysis

Cost utility analysis of reverse total shoulder arthroplasty

Kevin J. Renfree, MDa,b,*, Steven J. Hattrup, MDa, Yu-Hui H. Chang, MPH, PhDc

These authors prospectively analyzed outcomes and costs for primary reverse shoulder arthroplasty in 27 out of 30 initially enrolled patients with rotator cuff arthropathy (16 women and 14 men; mean age, 74.1 years [range, 61.1-87.3 years]). One patient died before the 2-year follow-up from unrelated causes, and 2 patients were lost to follow-up. 

Of interest were the comorbid conditions in these patients: obesity (73%), hypertension (70%), hyperlipidemia (43%), cardiac disease (27%), diabetes (17%), and pulmonary disease (13%).

Costs were documented, including professional fees, operating room and supply costs, and hospital care. 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. 

Interventions with an incremental ratio of <$50,000/quality-adjusted life-year are considered modestly cost effective. Interventions with an incremental ratio of <$25,000/quality-adjusted life-year are considered highly cost effective.

The authors point out that It will be important to reevaluate these patients after 5 years and 10 years to determine whether the QALY improvements are truly long lasting. The also point out that all of their patients had RSA for rotator cuff arthropathy, which generally yields results superior to those of revision RSA for failed arthroplasty and potentially for other conditions, such as proximal humeral fractures. Therefore, these cost-effectiveness data should not be extrapolated to additional indications for RSA. Finally, these patients had severely compromised shoulder function preoperatively (Simple Shoulder Test scores averaged 1.3 improving to 8.3 at 2 years); thus there was substantial opportunity for functional improvement.

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