OBJECTIVES: The aim of this study was to compare the cost-effectiveness of total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) in the management of osteoarthritis in patients with an intact rotator cuff in the UK. The analysis explores variation by age and gender.

METHODS: The cost-effectiveness analysis uses a lifetime cohort Markov model. Model parameters were informed by propensity score matching comparisons of TSA and HA in patients with osteoarthritis and an intact rotator cuff using data from the UK National Joint Registry. Health outcomes are measured as quality-adjusted life years (QALYs). QALYs and healthcare costs were estimated for age and gender subgroups. A probabilistic sensitivity analysis was performed separating parametric uncertainty from subgroup heterogeneity.

RESULTS: In all subgroups TSA was more cost-effective, with probability of being cost-effective about 70% for TSA versus 30% for HA at any willingness-to-pay threshold above of £1,100 per QALY. TSA was dominant in young patients (< 60 years) with a mean cost saving of £463 in men and £658 in women, and a mean QALY gain of 2 in both men and women. In patients aged 61-75 years there was a mean cost saving following HA of £395 in men and £181 in women, while QALYs remained superior following TSA with a 1.3 gain in men and 1.4 women. In the older cohort (> 75 years) the cost difference was highest and the QALY difference lowest; there was a cost saving following HA of £905 in men and £966 in women. The mean QALY gain remained larger after TSA: 0.7 in men and 0.9 in women.

CONCLUSIONS: TSA was more cost effective than HA in patients with osteoarthritis. QALYs were superior following TSA in all patients. Cost differences varied by age and TSA was dominant in young patients.