Grobet CE, Glanzmann MC, Eichler K, et al. - The present study was performed to explore the effect of total shoulder arthroplasty (TSA) on quality of life (QOL), direct medical costs and productivity losses, and evaluated the cost-utility ratio of TSA compared to ongoing nonoperative management using real-world data. In this prospective study, researchers enrolled patients with shoulder osteoarthritis and/or rotator cuff tear arthropathy indicated for anatomical or reverse TSA. They evaluated quality of life and shoulder function (Constant Score, Shoulder Pain and Disability Index, short version of the Disabilities of the Arm, Shoulder and Hand questionnaire, Subjective Shoulder Value) before (preop) and up to 2 years after surgery (postop). Researchers estimated a cost-utility ratio of 63,299 Swiss francs (CHF)/quality-adjusted life year (QALY) for TSA in Switzerland, which clearly falls below the often suggested 100,000 CHF/QALY threshold for acceptable cost-effectiveness using real-world direct medical cost data. It was shown that TSA becomes highly cost-effective with an incremental cost-effectiveness ratio of 35,546 CHF/QALY in view of productivity losses.