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

  • Osteoarthritis (T Appleton, Section Editor)
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Abstract

Purpose of review

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.

Recent findings

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.

Summary

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.

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Authors and Affiliations

  1. Faculty of Health Sciences, University of Western Ontario, London, ON, N6G 1H1, Canada

    Codie A. Primeau MSc, Ishita Joshi BHSc, Bryn O. Zomar MSc, Holly T. Philpott MSc, David D. McHugh BA & Jacquelyn D. Marsh PhD

  2. Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, ON, N6A 5B5, Canada

    Codie A. Primeau MSc, Ishita Joshi BHSc, Bryn O. Zomar MSc, Holly T. Philpott MSc, Brent A. Lanting MD, Edward M. Vasarhelyi MD & Jacquelyn D. Marsh PhD

  3. London Health Sciences Centre, University Hospital, London, ON, Canada

    Lyndsay E. Somerville PhD, Brent A. Lanting MD, Edward M. Vasarhelyi MD & Jacquelyn D. Marsh PhD

  4. Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada

    Lyndsay E. Somerville PhD, Brent A. Lanting MD & Edward M. Vasarhelyi MD

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  1. Codie A. Primeau MSc
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Key points

• Evaluating cost-effectiveness of interventions is critical for providing value-based care for patients yet only 1 in 3 studies investigating costs within the hip and knee arthroplasty literature meet the criteria of a full economic evaluation necessary to appropriately draw conclusions on cost-effectiveness and inform policy decision-making.

• Few studies (8%) compared surgical to non-surgical interventions.

• Cost-effectiveness of treatments may be dependent on the perspective analyzed; therefore, transparency in reporting the costing perspective is necessary as overall costs vary substantially in the proportion of direct and indirect costs.

• Consumers of economic evaluations in hip and knee arthroplasty literature need to assess the methodological quality of evidence, as many studies inappropriately conclude an intervention is “cost-effective” despite not conducting a full economic evaluation.

This article is part of the Topical Collection on Osteoarthritis

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Primeau, C.A., Joshi, I., Zomar, B.O. et al. Cost-Effectiveness of Arthroplasty Management in Hip and Knee Osteoarthritis: a Quality Review of the Literature. Curr Treat Options in Rheum 6, 160–190 (2020). https://doi.org/10.1007/s40674-020-00157-8

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