Study quantifies economic advantage of outpatient TSA for both patients and payors

A new research article published in Journal of Shoulder and Elbow Arthroplasty quantifies the economic advantage of outpatient total shoulder arthroplasty (TSA).

Researchers from Perelman School of Medicine at the University of Pennsylvania, Nova Southeastern University, The Hand & Upper Extremity Center of San Antonio, Hoag Orthopaedics, St. Charles Center for Orthopedics and Neurosurgery, and Rothman Orthopaedic Institute, initiated their study on the following premise: “While prior studies have demonstrated lower short-term costs associated with outpatient TSA, its long-term economic value compared with inpatient TSA remains unclear.”

Employing a Markov model analysis, they compared “outpatient and inpatient TSA from a U.S. payor perspective over a 20-year horizon.” Calling outpatient TSA “the dominant strategy,” they found the following:

• Mean discounted lifetime costs were lower for outpatient TSA compared with inpatient TSA ($23,375 vs. $28,402).
• Outpatient TSA was associated with a modest increase in effectiveness, generating 10.436 quality-adjusted life-years (QALYs) compared with 10.427 QALYs for inpatient TSA.
• In probabilistic sensitivity analysis, outpatient TSA demonstrated a mean incremental cost of −$5,142 and a mean incremental effectiveness of 0.009 QALYs.
• At a willingness-to-pay threshold of $100,000 per QALY, outpatient TSA was cost-effective in 89% of simulations and economically dominant in 61.1% of simulations.

The researchers concluded, “Outpatient TSA is a cost-effective and economically dominant strategy compared with inpatient TSA, driven primarily by lower initial procedural costs. Sensitivity analyses demonstrated that outpatient TSA remained cost-effective even when differences in perioperative complication and revision rates were substantially reduced.”

In a Hoag press release about the study, senior author Hafiz F. Kassam, MD, director of shoulder reconstruction at Hoag Orthopedic Institute, stated that the results demonstrate that “outpatient shoulder replacement can provide excellent value for both patients and the healthcare system… Our study concluded that for straightforward, primary shoulder arthroplasty, the outpatient setting offers a strong economic advantage while maintaining similar long-term patient outcomes compared with inpatient surgery.”

Hoag stated that “the findings suggest outpatient shoulder replacement may help healthcare systems and insurers advance value-based care goals in carefully selected patients. The study emphasizes proper patient selection, noting that inpatient care may remain more appropriate for higher-risk surgical candidates and economic drivers should not override surgeon judgement on site of care.”

Access the full study here.