OBJECTIVES : Shoulder osteoarthritis and/or rotator cuff tear arthropathy may have a substantial impact on patients’ quality of life (QOL) and imply a significant cost burden. Total shoulder arthroplasty (TSA) is one established standard therapy to treat this condition. However, little is known about the impact of TSA on QOL and costs in real world settings. Therefore, we examined the cost-effectiveness of TSA from a societal perspective in Switzerland.

METHODS : In a prospective before-after study, we included all consecutive patients of a tertiary orthopaedic centre with shoulder osteoarthritis and/or rotator cuff arthropathy indicated for anatomic or reverse TSA. Quality of life (EQ-5D-5L; [utilities: 0-1]) was assessed before (pre-OP) and up to two years after surgery (post-OP). Swiss health and accident insurance companies provided all-diagnoses direct medical cost data from one year pre-OP up to two years post-OP. Indirect costs were assessed using the work productivity and activity impairment questionnaire (WPAI). The incremental cost-effectiveness ratio (ICER) was calculated using incremental utilities and total costs, with the year pre-OP serving as the control period.

RESULTS : 150 patients (mean age 71 years; 58% female, 21% working) were included. The mean EQ-5D-5L index improved from 0.68 (pre-OP) to 0.89 and 0.88 (1 and 2 years post-OP respectively; p < 0.001). Mean total costs were CHF (Swiss Francs) 19’077 (pre-OP), CHF 37’671 and CHF 13’241 (1 and 2 years post-OP respectively; 2018 conversion rate CHF to €: 0.87). The ICER was 34’699 CHF/QALY (95%-CI: 9,845 to 59,554 CHF/QALY) until two years post-OP compared to the pre-OP control period.

CONCLUSIONS : This study is the first to analyse real world cost data and calculate the cost-utility ratio of TSA in Switzerland. Patients with TSA show a significant and clinically relevant improvement of QOL. TSA is cost-effective already two years post-OP compared to conservative treatment before surgery.