The Quality of Cost-Utility Analyses in Orthopedic Trauma

Abstract

As health care in the United States transitions toward a value-based model, there is increasing interest in applying cost-effectiveness analysis within orthopedic surgery. Orthopedic trauma care has traditionally underemphasized economic analysis. The goals of this review were to identify US-based cost-utility analysis in orthopedic trauma, to assess the quality of the available evidence, and to identify cost-effective strategies within orthopedic trauma. Based on a review of 971 abstracts, 8 US-based cost-utility analyses evaluating operative strategies in orthopedic trauma were identified. Study findings were recorded, and the Quality of Health Economic Studies (QHES) instrument was used to grade the overall quality. Of the 8 studies included in this review, 4 studies evaluated hip and femur fractures, 3 studies analyzed upper extremity fractures, and 1 study assessed open tibial fracture management. Cost-effective interventions identified in this review include total hip arthroplasty (over hemiarthroplasty) for femoral neck fractures in the active elderly, open reduction and internal fixation (over nonoperative management) for distal radius and scaphoid fractures, limb salvage (over amputation) for complex open tibial fractures, and systems-based interventions to prevent delay in hip fracture surgery. The mean QHES score of the studies was 79.25 (range, 67-89). Overall, there is a paucity of cost-utility analyses in orthopedic trauma; however, the available evidence suggests that certain operative interventions can be cost-effective. The quality of these studies, however, is fair, based on QHES grading. More attention should be paid to evaluating the cost-effectiveness of operative intervention in orthopedic trauma.

Cost-utility studies in upper limb orthopaedic surgery

“…Reviews within the subspecialties of sports medicine 2 and trauma 3 have found the quality to be strong, with QHES averages of 81.8 and 79.25, respectively. Brauer and colleagues have noted more orthopaedic studies complying with the recommendations of the First Panel after 1998 5 .…”

“…In the field of orthopaedics, prior systematic reviews have assessed the quality of CEAs across sports 2 and trauma 3 , finding the overall quality of studies to be good in these orthopaedic subspecialties. However, there has been no systematic examination of CEAs in upper extremity surgery.…”

The assessment of pharmacoeconomic studies quality of Levodopa’s use for the management of Parkinson’s diseases, 2010-2015

“…In this study, a review of the pharmacoeconomic evaluations for the use of Levodopa in Parkinson's disease was carried out, based on the QHES instrument [22], which qualifies methodological quality and has been used by other authors previously [45][46][47][48][49].Only the articles that met inclusion criteria and were considered of cost-utility were taken, finding that the five articles analyzed obtained an overall average score of 77.2 out of 100. This reflects that these studies are of good quality, and this is probably attributable to the fact that they were recently carried out following the current guidelines.…”

Cost-Effectiveness of Operative Versus Non-Operative Treatment for Clavicle Fracture: a Systematic Literature Review

“…Since the introduction and application of the QHES instrument, the reported mean and median scores have been between 80 and 90. Therefore, the authors considered a QHES score of greater than 85 as an indicator of high quality [31][32][33][34].…”