Cost-effectiveness of anatomic total shoulder arthroplasty versus pyrocarbon hemiarthroplasty for glenohumeral osteoarthritis: a 10-year Markov cost-utility analysis
9 affiliations
- 1Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- 2Nova Southeastern University, Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, FL, USA
- 3Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
- 4Midwest Orthopedics, Rush University Medical Center, Chicago, IL, USA
- 5University Hospitals Drusinsky Sports Medicine Institute, Cleveland, USA
- 6Alps Surgery Institute, Clinique Générale Annecy, Annecy, France
- 7Department of Orthopedics, New-York Presbyterian/Columbia University Irving Medical Center, New York, USA
- 8Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
- 9Hoag Orthopaedic Institute, Irvine, CA, USA
Abstract
Background: Pyrocarbon hemiarthroplasty (HA) is used for glenohumeral osteoarthritis in younger patients to preserve glenoid bone, but its cost-effectiveness against anatomic total shoulder arthroplasty (aTSA) has not been evaluated.
Methods: A Markov cost-utility model compared Tornier pyrocarbon HA, hybrid aTSA, and all-polyethylene aTSA in a 65-year-old over 10 years from a US hospital perspective (2026 dollars, 3% discount). Well-state utilities were equalized and a revision-year decrement was applied. Threshold, one-way, scenario, and probabilistic analyses were performed, including younger-patient scenarios using age-specific registry aTSA revision rates.
Results: Hybrid aTSA dominated pyrocarbon HA (−2,332; +0.015 quality−adjusted life years [QALYs]), as did all−polyethylene aTSA (−1,633; +0.009 QALYs), with 84% and 75% probability of cost-effectiveness at $50,000 per QALY. Pyrocarbon HA became cost-effective only if its 10-year revision rate fell from 10.6% to 1.0% or 4.2% or its cost fell by $3,066 or $2,063. aTSA lost its advantage when its own 10-year revision rate exceeded 12.8%. In patients under 65, aTSA remained marginally cost-effective with modern-prosthesis registry revision rates (10.5% at 10 years; incremental net monetary benefit $711) and pyrocarbon HA dominated with all-era age-specific rates (15.9%; −$531; +0.010 QALYs).
Conclusion: In a typical 65-year-old, aTSA dominates pyrocarbon HA. In patients aged less than 65 years, the strategies approach economic equivalence, and pyrocarbon HA is favored once aTSA revision exceeds roughly 13% at 10 years. Age-specific survivorship drives economic advantage.
Related
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BibTeX
@article{adio2026costeffectiveness,
title = {{Cost-effectiveness of anatomic total shoulder arthroplasty versus pyrocarbon hemiarthroplasty for glenohumeral osteoarthritis: a 10-year Markov cost-utility analysis}},
author = {Akin A. Adio and Andrew Bouras and Joseph A. Abboud and Grant E. Garrigues and Robert J. Gillespie and Thibault Lafosse and William N. Levine and Frederick A. Matsen and Hafiz F. Kassam},
journal = {Journal of Shoulder and Elbow Arthroplasty},
year = {2026},
month = sep,
doi = {10.1016/j.jsea.2026.100094},
url = {https://doi.org/10.1016/j.jsea.2026.100094},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Cost-effectiveness of anatomic total shoulder arthroplasty versus pyrocarbon hemiarthroplasty for glenohumeral osteoarthritis: a 10-year Markov cost-utility analysis
AU - Akin A. Adio
AU - Andrew Bouras
AU - Joseph A. Abboud
AU - Grant E. Garrigues
AU - Robert J. Gillespie
AU - Thibault Lafosse
AU - William N. Levine
AU - Frederick A. Matsen
AU - Hafiz F. Kassam
PY - 2026
DA - 2026/09/23
JO - Journal of Shoulder and Elbow Arthroplasty
DO - 10.1016/j.jsea.2026.100094
UR - https://doi.org/10.1016/j.jsea.2026.100094
AB - Background: Pyrocarbon hemiarthroplasty (HA) is used for glenohumeral osteoarthritis in younger patients to preserve glenoid bone, but its cost-effectiveness against anatomic total shoulder arthroplasty (aTSA) has not been evaluated. Methods: A Markov cost-utility model compared Tornier pyrocarbon HA, hybrid aTSA, and all-polyethylene aTSA in a 65-year-old over 10 years from a US hospital perspective (2026 dollars, 3% discount). Well-state utilities were equalized and a revision-year decrement was applied. Threshold, one-way, scenario, and probabilistic analyses were performed, including younger-patient scenarios using age-specific registry aTSA revision rates. Results: Hybrid aTSA dominated pyrocarbon HA (−2,332; +0.015 quality−adjusted life years [QALYs]), as did all−polyethylene aTSA (−1,633; +0.009 QALYs), with 84% and 75% probability of cost-effectiveness at $50,000 per QALY. Pyrocarbon HA became cost-effective only if its 10-year revision rate fell from 10.6% to 1.0% or 4.2% or its cost fell by $3,066 or $2,063. aTSA lost its advantage when its own 10-year revision rate exceeded 12.8%. In patients under 65, aTSA remained marginally cost-effective with modern-prosthesis registry revision rates (10.5% at 10 years; incremental net monetary benefit $711) and pyrocarbon HA dominated with all-era age-specific rates (15.9%; −$531; +0.010 QALYs). Conclusion: In a typical 65-year-old, aTSA dominates pyrocarbon HA. In patients aged less than 65 years, the strategies approach economic equivalence, and pyrocarbon HA is favored once aTSA revision exceeds roughly 13% at 10 years. Age-specific survivorship drives economic advantage.
SN - 2471-5492
ER -