The proximal humerus is an especially common fracture site in patients over 60, for whom the implications of disability and loss of independence are marked. These fractures can be operatively treated with open reduction and internal fixation (ORIF), proximal humerus nail (PHN), hemiarthroplasty (HA), or reverse total shoulder arthroplasty (RTSA). Though more expensive than other techniques, RTSA has rapidly gained popularity. Prior studies have described outcomes of proximal humerus fracture management with various techniques, yet the optimal approach in the elderly remains contentious. The purpose of this study was to assess relative cost-effectiveness of non-operative management, ORIF, PHN, HA, and RTSA for treatment of proximal humerus fractures in patients age 60 and over.