Analysis of shoulder arthroplasty literature finds the procedure to be cost-effective
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Recently published results show total shoulder arthroplasty is a cost-effective procedure and, according to quality of health economic studies scores, most cost analysis literature on the subject is high quality.
William M. Cregar, MD, and colleagues performed a systematic review of nine studies and examined the cost-effectiveness of total shoulder arthroplasty for the treatment of various shoulder pathologies. A total of 196 studies were screened for inclusion.
Cregar and colleagues used the quality of health economic studies (QHES) instrument to evaluate the quality of the cost analyses. They also performed one-sided Fisher exact testing to identify predictors of low-quality (< 25th percentile QHES score) and high-quality (> 75th percentile QHES score) research, according to the study.
“The average QHES score among all studies was 86.22,” the researchers wrote in the study. “Failure to include an annual cost discounting rate was associated with a low-quality QHES score. In addition, including a discussion of the magnitude and direction of potential biases was associated with a high-quality score,” they added.
“We believe the value of cost-effectiveness research within the field of orthopedics, and in particular shoulder surgery, is critical as considerations of cost have become emphasized more heavily within our health care system,” the researchers wrote. “Cost-effectiveness literature has the ability to critically evaluate new technology or interventions with significant implications regarding its subsequent implementation and coverage,” they concluded.
Perspective
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John W. Sperling, MD, MBA
As we enter an era with greater scrutiny on the cost of health care, demonstrating the value of commonly performed procedures is essential. Dr. Cregar and colleagues should be congratulated on a very well written review of studies that examine the cost-effectiveness of shoulder arthroplasty. Using a comprehensive approach, the authors not only carefully identified articles that focused on the cost-effectiveness of shoulder arthroplasty, but also graded the quality of these reports.
The authors determined that shoulder replacement is a high value procedure when used to address a breadth of shoulder pathologies. The authors also reported that the quality of these articles is comparatively good. This research will serve as an important framework for future studies evaluating the value of frequently performed procedures in orthopedic surgery.
Perspective
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April D. Armstrong, BSc(PT), MSc, MD, FRCSC
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