Reverse-total shoulder arthroplasty cost-effectiveness:A quality-adjusted life years comparison with total hip arthroplasty

AIM:To compare reverse-total shoulder arthroplasty(RSA)cost-effectiveness with total hip arthroplasty cost-effectiveness.METHODS:This study used a stochastic model and decision-making algorithm to compare the costeffectiveness of RSA and total hip arthroplasty.Fifteen patients underwent pre-operative,and 3,6,and 12 mo post-operative clinical examinations and Short Form-36 Health Survey completion.Short form-36 Health Survey subscale scores were converted to EuroQ ual Group Five Dimension Health Outcome scores and compared with historical data from age-matched patients who had undergone total hip arthroplasty.Quality-adjusted life year(QALY)improvements based on life expectancies were calculated.RESULTS:The cost/QALY was $3900 for total hip arthroplasty and $11100 for RSA.After adjusting the model to only include shoulder-specific physical function subscale items,the RSA QALY improved to 2.8years,and its cost/QALY decreased to $8100.CONCLUSION:Based on industry accepted standards,cost/QALY estimates supported both RSA and total hip arthroplasty cost-effectiveness.Although total hip arthroplasty remains the quality of life improvement "gold standard" among arthroplasty procedures,cost/QALY estimates identified in this study support the growing use of RSA to improve patient quality of life.

Cervical Spine Alignment and Motion in the Acute Management of Potential Catastrophic Cervical Spine Injuries in Sport

The incidence of spinal cord injury in the United Statesis esti mated to be 11,000 newcases each year[1].Sport participation constitutes the fourth most common cause[1](approxi mately 8·7%)of these injuries