Cost-Effectiveness of Arthroplasty Management in Hip and Knee Osteoarthritis: a Quality Review of the Literature

Abstract

Musculoskeletal disorders are a leading contributor to healthcare resource use and reduced quality of life, particularly in osteoarthritis of the hip/knee. Consequently, the volume of arthroplasty procedures continues to rise and there is a critical need to identify interventions that provide value-based care. Economic evaluations that assess both cost and health outcomes simultaneously allow clinicians and policymakers to make informed decisions regarding cost-effective interventions. The purpose of this review was to summarize and evaluate the methodological quality of economic evaluations of hip/knee interventions in arthroplasty. We identified 384 studies. Two-thirds did not meet the criteria for full economic evaluations (compared costs independently). Several studies (28%) inappropriately concluded interventions were cost-effective. Using a validated quality assessment tool, we determined the quality of full economic evaluations in hip/knee arthroplasty is generally good; however, important areas for quality improvement are related to reporting perspective, costing methodology, and funding. Value-based care in arthroplasty relies on the quality of the literature. Although the quality is generally good, few full economic evaluations are published in arthroplasty. Yet, these are necessary to appropriately infer intervention cost-effectiveness. Unfortunately, clinical decisions continue to be made using highly cited low-quality or partial economic evaluations.