Cost-utility studies in upper limb orthopaedic surgery

Rajan, Prashant V.; Qudsi, Rameez A.; Dyer, George S.M.; Losina, Elena

doi:10.1302/0301-620x.100b11.bjj-2018-0246.r1

Cited by 8 publications

(15 citation statements)

References 54 publications

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“…The key search terms used were “hip arthroscopy” paired with “cost,” “utility,” “quality,” and “economic evaluation.” The Tufts University CEA Registry was searched as well. 34 This systematic review was prospectively registered on PROSPERO (CRD42020172991).…”

Section: Methodsmentioning

confidence: 99%

“…The QHES score assesses factors such as sources of data, time horizons, and data analyses. A study with a QHES score >75 can be considered to be high quality, 34 while a QHES score >90 is excellent quality. 27 If there were any disagreements, 2 authors (C.C.G.…”

Section: Methodsmentioning

confidence: 99%

“…The Tufts University CEA Registry was searched as well. 34 This systematic review was prospectively registered on PROSPERO (CRD42020172991).…”

Section: Search Strategymentioning

confidence: 99%

“…Although reviews 7 , 27 , 30 , 34 have been conducted on the cost-effectiveness of other orthopaedic procedures, none have specifically focused on hip arthroscopy. Thus, the purpose of this study was to systematically review the cost-effectiveness of hip arthroscopy for treating FAI and labral tears.…”

mentioning

confidence: 99%

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Cost-Effectiveness of Hip Arthroscopy for Treatment of Femoroacetabular Impingement Syndrome and Labral Tears: A Systematic Review

Kyin

Chen

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Hip arthroscopy has frequently been shown to produce successful outcomes as a treatment for femoroacetabular impingement (FAI) and labral tears. However, there is less literature on whether the favorable results of hip arthroscopy can justify the costs, especially when compared with a nonoperative treatment. Purpose: To systematically review the cost-effectiveness of hip arthroscopy for treating FAI and labral tears. Study Design: Systematic review; Level of evidence, 3. Methods: PubMed/MEDLINE, Embase, and Cochrane Library databases, and the Tufts University Cost-Effectiveness Analysis Registry were searched to identify articles that reported the cost per quality-adjusted life-year (QALY) generated by hip arthroscopy. The key terms used were “hip arthroscopy,” “cost,” “utility,” and “economic evaluation.” The threshold for cost-effectiveness was set at $50,000/QALY. The Methodological Index for Non-Randomized Studies instrument and Quality of Health Economic Studies (QHES) score were used to determine the quality of the studies. This study was prospectively registered on PROSPERO (CRD42020172991). Results: Six studies that reported the cost-effectiveness of hip arthroscopy were identified, and 5 of these studies compared hip arthroscopy to a nonoperative comparator. These studies were found to have a mean QHES score of 85.2 and a mean cohort age that ranged from 33-37 years. From both a health care system perspective and a societal perspective, 4 studies reported that hip arthroscopy was more costly but resulted in far greater gains than did nonoperative treatment. The preferred treatment strategy was most sensitive to duration of benefit, preoperative osteoarthritis, cost of the arthroscopy, and the improvement in QALYs with hip arthroscopy. Conclusion: In the majority of the studies, hip arthroscopy had a higher initial cost but provided greater gain in QALYs than did a nonoperative treatment. In certain cases, hip arthroscopy can be cost-effective given a long enough duration of benefit and appropriate patient selection. However, there is further need for literature to analyze willingness-to-pay thresholds.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…The Tufts University CEA Registry was searched as well. 34 This systematic review was prospectively registered on PROSPERO (CRD42020172991).…”

Section: Search Strategymentioning

confidence: 99%

mentioning

confidence: 99%

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Cost-Effectiveness of Hip Arthroscopy for Treatment of Femoroacetabular Impingement Syndrome and Labral Tears: A Systematic Review

Kyin

Chen

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…For example, as demonstrated by Rajan et al, there has been a growing number of lower-quality orthopaedic-based CUA studies (assessed using the QHES) relating to the management options of the upper limb in recent years. 48 …”

Section: Grading the Quality Of Cua Studiesmentioning

confidence: 99%

Understanding cost-utility analysis studies in the trauma and orthopaedic surgery literature

et al. 2021

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Cost-utility analysis (CUA) studies are becoming increasingly important due to the need to reduce healthcare spending, especially in the field of trauma and orthopaedics. There is an increasing need for trauma and orthopaedic surgeons to understand these economic evaluations to ensure informed cost-effective decisions can be made to benefit the patient and funding body. This review discusses the fundamental principles required to understand CUA studies in the literature, including a discussion of the different methods employed to assess the health outcomes associated with different management options and the various approaches used to calculate the costs involved. Different types of model design may be used to conduct a CUA which can be broadly categorized into real-life clinical studies and computer-simulated modelling. We discuss the main types of study designs used within each category. We also cover the different types of sensitivity analysis used to quantify uncertainty in these studies and the commonly employed instruments used to assess the quality of CUAs. Finally, we discuss some of the important limitations of CUAs that need to be considered. This review outlines the main concepts required to understand the CUA literature and provides a basic framework for their future conduct. Cite this article: EFORT Open Rev 2021;6:305-315. DOI: 10.1302/2058-5241.6.200115

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Economic evaluation of operative versus nonoperative treatment of a humeral shaft fracture: economic analyses alongside a multicenter prospective cohort study (HUMMER)

Bergen

Lieshout

Mahabier

et al. 2022

Eur J Trauma Emerg Surg

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Purpose Operative treatment of a humeral shaft fracture results in faster recovery than nonoperative treatment. The cost-effectiveness, in terms of costs per Quality-Adjusted Life Year (QALY) gained (Dutch threshold €20,000-€80,000) or minimal important change (MIC) in disability reduced (DASH 6.7), is unknown. The aim of this study was to determine cost-utility and cost-effectiveness of operative versus nonoperative treatment in adults with a humeral shaft fracture type 12A or 12B. Methods This study was performed alongside a multicenter prospective cohort study. Costs for health care and lost productivity until one year after trauma were calculated. The incremental cost-utility ratio (ICUR) was reported in costs per QALY (based on the EuroQoL-5D-3L (EQ-5D)) gained. The incremental cost-effectiveness ratio (ICER) was reported in costs per MIC (based on the DASH score at three months) reduced. Results Overall, 245 patients were treated operatively and 145 nonoperatively. In the operative group, the mean total costs per patient (€11,925 versus €8793; p < 0.001) and QALYs (0.806 versus 0.778; p < 0.001) were higher. The ICUR of operative treatment was €111,860 per QALY gained (i.e., €3132/0.028). The DASH was 7.3 points (p < 0.001) lower in the operative group. The ICER of operative treatment was €2880 per MIC in disability reduced (i.e., €3132/7.3*6.7). Conclusion Due to the limited effect of treatment on quality of life measured with the EQ-5D, the ICUR of operative treatment (€111,860 per QALY gained) exceeds the threshold. However, the incremental costs of €2880 per clinically meaningful difference in DASH are much lower and suggest that operative treatment for a humeral shaft fracture is cost-effective.

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Cost-utility studies in upper limb orthopaedic surgery

Cited by 8 publications

References 54 publications

Cost-Effectiveness of Hip Arthroscopy for Treatment of Femoroacetabular Impingement Syndrome and Labral Tears: A Systematic Review

Cost-Effectiveness of Hip Arthroscopy for Treatment of Femoroacetabular Impingement Syndrome and Labral Tears: A Systematic Review

Understanding cost-utility analysis studies in the trauma and orthopaedic surgery literature

Economic evaluation of operative versus nonoperative treatment of a humeral shaft fracture: economic analyses alongside a multicenter prospective cohort study (HUMMER)

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