Work

Cost-effectiveness of anatomic total shoulder arthroplasty versus pyrocarbon hemiarthroplasty for glenohumeral osteoarthritis: a 10-year Markov cost-utility analysis

Year: 2026

Type: article

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.

Source: Journal of Shoulder and Elbow Arthroplasty

DOI: 10.1016/j.jsea.2026.100094