CORR Insights(®): current status of cost utility analyses in total joint arthroplasty: a systematic review.

Abstract

N wachukwu and colleagues have accurately gauged the state of knowledge within the joint arthroplasty literature relating to a segment of healthcare economics known as cost-utility analysis. It is a meaningful contribution for two reasons. First, it reflects a trend toward greater focus on quantifiably assessing the economic impact of this high cost orthopaedic intervention from multiple perspectives. Second, it indicates the evolution toward studies that have relevance to a healthcare economy that has shifted toward patient-centered and self-directed care. Cost utility analysis is a subset of cost-effectiveness research that accounts for the individual’s measure of health benefit resulting from an intervention of known incremental cost. This ‘‘utility’’ is typically expressed in terms of quality adjusted life-years (QALY). This is used increasingly to compare the impact of different interventions, and is often expressed as an incremental cost-effectiveness ratio. This framework for evaluating the practical benefit of joint restoration procedures has grown beyond the health policy research segment of orthopaedics and has now gaining widespread acceptance in the clinical arthroplasty community. Aside from reporting the recent growth of cost utility studies in this literature, one of the key contributions of the study by Nwachukwu and colleagues is the application of objectivity in evaluating study quality. Through the use of the Quality of Health Economic Studies instrument, the authors introduce a new standard for evaluating the practical relevance of cost utility analyses in the joint arthroplasty literature. The other key contribution is in identifying the gap in the literature involving studies that compare operative and non-operative interventions for arthritic conditions of the hip and knee. The authors note that patients presenting for joint arthroplasty have already failed nonoperative treatment as a potential reason for this finding.