Innovations to Speed Treatment May Be Cost-Effective for Hip Fracture

Abstract

The paper “An Economic Evaluation of a Systems-Based Strategy to Expedite Surgical Treatment of Hip Fractures” by Dy et al. is a cost-effectiveness analysis of two systems-based strategies to expedite surgical repair of hip fractures. Reading a cost-effectiveness analysis may seem foreign to many JBJS readers. These analyses are based on models that include probabilities of outcomes derived from systematic literature reviews, utilities based on qualitative surveys of the value that patients place on various health states, and cost estimates based on economic data. These studies involve a whole new vocabulary: QALYs (quality-adjusted life years), Monte Carlo simulation, sensitivity analysis, ICER (incremental cost-effectiveness ratio), utilities, and time trade-off. It is easy for an orthopaedic surgeon to skip over this article, saying, “I don't understand the methodology,” “It's an abstract model,” or “I'm not a health care economist.” However, economic analyses in orthopaedic surgery have never been more important. Contemporary forces in medicine have driven economic analyses to the foreground. The federal government, state governments, and insurers are analyzing cost-effectiveness data to determine how to “ration” limited resources. Hospitals and medical groups are trying to limit costs yet still provide effective care. Quality and safety initiatives are being implemented from all directions. Accountable Care Organizations (ACOs) are looming on the horizon. There can be an inherent mistrust of decision analysis and cost-effectiveness analysis among clinicians who mistrust the modeling process and also among those who view these techniques as a means to reduce costs, impinge on physician autonomy, corrupt the doctor-patient relationship, and compromise individualized patient care. In fact, the goal of decision analysis and cost-effectiveness analysis is to optimize …