The Economics of New Technology

Abstract

Emerging technologies have been implicated in the steady rise in healthcare expenditures. Although expensive, new technology has allowed for the treatment of very severe deformities within the field of limb lengthening and reconstruction. Beginning as early as the Ilizarov method of distraction osteogenesis, many of the treatments have resulted in impressive clinical results at the cost of being resource intensive. In addition to the economic cost, the treatments placed a significant burden on the patient who was forced to remain in external fixation for long periods of time. To decrease time in external fixation, lengthening over a nail and lengthening and then nailing were developed. Although certainly an improvement, external fixation was still a major component of treatment, and complications associated with its use remained. The advent of the motorized internal lengthening nail (MLN) has obviated the use of external fixation in a select group of patients and seems to be a step forward for the field. Still, the high upfront costs related to the price of the implant have served to limit its use in resource-poor areas and decrease adoption among cost-conscious surgeons. Although seemingly more expensive, the costs of MLN may be offset by the fact that this treatment requires fewer surgical procedures and may have fewer complications. This article reviews the available evidence with regards to the hospital, surgeon, and total cost when comparing lengthening over a nail versus MLN in the femur and lengthening and then nailing versus MLN in the tibia.