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Current Reviews in Musculoskeletal Medicine

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01-06-2017 | Orthopaedic Health Policy (A Miller, section editor)

Technology assessment and cost-effectiveness in orthopedics: how to measure outcomes and deliver value in a constantly changing healthcare environment

Authors: Jeremy M Burnham, Fabien Meta, Vincent Lizzio, Eric C. Makhni, Kevin J Bozic

Published in: Current Reviews in Musculoskeletal Medicine | Issue 2/2017

Abstract

Purpose of review

The purpose of this study is to review the basic concepts of healthcare value, patient outcome measurement, and cost-effectiveness analyses as they relate to the introduction of new surgical techniques and technologies in the field of orthopedic surgery.

Recent findings

An increased focus on financial stewardship in healthcare has resulted in a plethora of cost-effectiveness and patient outcome research. Recent research has made great progress in identifying orthopedic technologies that provide exceptional value and those that do not meet adequate standards for widespread adoption.

Summary

As the pace of technological innovation advances in lockstep with an increased focus on value, orthopedic surgeons will need to have a working knowledge of value-based healthcare decision-making. Value-based healthcare and cost-effectiveness analyses can aid orthopedic surgeons in making ethical and fiscally responsible treatment choices for their patients.

Day CS, Park DJ, Rozenshteyn FS, Owusu-Sarpong N, Gonzalez A. Analysis of FDA-approved orthopaedic devices and their recalls. J Bone Joint Surg Am. 2016;98(6):517–24. doi:10.2106/JBJS.15.00286.CrossRefPubMed

Belatti DA, Phisitkul P. Trends in orthopedics: an analysis of Medicare claims, 2000-2010. Orthopedics. 2013;36(3):e366–72. doi:10.3928/01477447-20130222-28.CrossRefPubMed

Lamiraud K, Lhuillery S. Endogenous technology adoption and medical costs. Health Econ. 2016;25(9):1123–47. doi:10.1002/hec.3361.CrossRefPubMed

Suter LG, Paltiel AD, Rome BN, Solomon DH, Thornhill TS, Abrams SK, et al. Placing a price on medical device innovation: the example of total knee arthroplasty. PLoS One. 2013;8(5):e62709. doi:10.1371/journal.pone.0062709.CrossRefPubMedPubMedCentral

•• Nwachukwu BU, Hamid KS, Bozic KJ. Measuring value in orthopaedic surgery. JBJS Rev. 2013;1(1) doi:10.2106/JBJS.RVW.M.00067. Excellent review of value measurements in orthopedic surgery

Hawkins RJ. Recommendations for evaluating and selecting appropriately valued outcomes measures. Instr Course Lect. 2016;65:587–92.PubMed

Appleby J, Poteliakhoff E, Shah K, Devlin N. Using patient-reported outcome measures to estimate cost-effectiveness of hip replacements in English hospitals. J R Soc Med. 2013;106(8):323–31. doi:10.1177/0141076813489678.CrossRefPubMedPubMedCentral

Delaunay C. Registries in orthopaedics. Orthop Traumatol Surg Res. 2015;101(1 Suppl):S69–75. doi:10.1016/j.otsr.2014.06.029.CrossRefPubMed

• Mohtadi N. Outcome measure development.pdf. Instr Course Lect. 2016;65. Discusses important factors when creating or choosing an outcome measure

10.

Rolfson O, Rothwell A, Sedrakyan A, Chenok KE, Bohm E, Bozic KJ, et al. Use of patient-reported outcomes in the context of different levels of data. J Bone Joint Surg Am. 2011;93(Suppl 3):66–71. doi:10.2106/JBJS.K.01021.CrossRefPubMedPubMedCentral

11.

Schamber EM, Takemoto SK, Chenok KE, Bozic KJ. Barriers to completion of patient reported outcome measures. J Arthroplast. 2013;28(9):1449–53. doi:10.1016/j.arth.2013.06.025.CrossRef

12.

Bowling A. Mode of questionnaire administration can have serious effects on data quality. J Public Health (Oxf). 2005;27(3):281–91. doi:10.1093/pubmed/fdi031.CrossRef

13.

Chenok K, Teleki S, SooHoo NF, Huddleston 3rd J, Bozic KJ. Collecting patient-reported outcomes: lessons from the California Joint Replacement Registry. EGEMS (Wash DC). 2015;3(1):1196. doi:10.13063/2327-9214.1196.

14.

Rolfson O, Wissig S, van Maasakkers L, Stowell C, Ackerman I, Ayers D, et al. Defining an international standard set of outcome measures for patients with hip or knee osteoarthritis: consensus of the international consortium for health outcomes measurement hip and knee osteoarthritis working group. Arthritis Care Res. 2016;68(11):1631–9. doi:10.1002/acr.22868.CrossRef

15.

Wang D, Jones M, Khair M, Miniaci A. Patient-reported outcome measures for the knee. J Knee Surg. 2010;23(03):137–51. doi:10.1055/s-0030-1268691.CrossRefPubMed

16.

Makhni EC, Swart E, Steinhaus ME, Mather 3rd RC, Levine WN, Bach Jr BR, et al. Cost-effectiveness of reverse total shoulder arthroplasty versus arthroscopic rotator cuff repair for symptomatic large and massive rotator cuff tears. Arthroscopy. 2016;32(9):1771–80. doi:10.1016/j.arthro.2016.01.063.CrossRefPubMed

17.

•• Baumhauer JF, Bozic KJ. Value-based healthcare: patient-reported outcomes in clinical decision making. Clin Orthop Relat Res. 2016;474(6):1375–8. doi:10.1007/s11999-016-4813-4. Reference 17 discusses the integrateion between patient outcomes measures and the determination of value in orthopedic surgery CrossRefPubMed

18.

•• Najjar PA, Strickland M, Kaplan RS. Time-driven activity-based costing for surgical episodes. JAMA Surg. 2016; doi:10.1001/jamasurg.2016.3356. Reference 18 is an effective review of the time-driven activity-based method of costing

19.

Ken Lee KH, Matthew Austin J, Pronovost PJ. Developing a measure of value in health care. Value Health. 2016;19(4):323–5. doi:10.1016/j.jval.2014.12.009.CrossRefPubMed

20.

El Alaoui S, Lindefors N. Combining time-driven activity-based costing with clinical outcome in cost-effectiveness analysis to measure value in treatment of depression. PLoS One. 2016;11(10):e0165389. doi:10.1371/journal.pone.0165389.CrossRefPubMedPubMedCentral

21.

Sharan AD, Schroeder GD, West ME, Vaccaro AR. Understanding time-driven activity-based costing. Clin Spine Surg. 2016;29(2):62–5. doi:10.1097/BSD.0000000000000360.PubMed

22.

Waters PM. Value in pediatric orthopaedic surgery health care: the role of time-driven activity-based cost accounting (TDABC) and standardized clinical assessment and management plans (SCAMPs). J Pediatr Orthop. 2015;35(5 Suppl 1):S45–7. doi:10.1097/BPO.0000000000000547.CrossRefPubMed

23.

Schutzer ME, Arthur DW, Anscher MS. Time-driven activity-based costing: a comparative cost analysis of whole-breast radiotherapy versus balloon-based brachytherapy in the management of early-stage breast cancer. J Oncol Pract. 2016;12(5):e584–93. doi:10.1200/JOP.2015.008441.CrossRefPubMed

24.

Crott R, Lawson G, Nollevaux MC, Castiaux A, Krug B. Comprehensive cost analysis of sentinel node biopsy in solid head and neck tumors using a time-driven activity-based costing approach. Eur Arch Otorhinolaryngol. 2016;273(9):2621–8. doi:10.1007/s00405-016-4089-z.CrossRefPubMed

25.

Balakrishnan K, Goico B, Arjmand EM. Applying cost accounting to operating room staffing in otolaryngology: time-driven activity-based costing and outpatient adenotonsillectomy. Otolaryngol Head Neck Surg. 2015;152(4):684–90. doi:10.1177/0194599814568273.CrossRefPubMed

26.

Nwachukwu BU, Schairer WW, Bernstein JL, Dodwell ER, Marx RG, Allen AA. Cost-effectiveness analyses in orthopaedic sports medicine: a systematic review. Am J Sports Med. 2015a;43(6):1530–7. doi:10.1177/0363546514544684.CrossRefPubMed

27.

Nwachukwu BU, Bozic KJ, Schairer WW, Bernstein JL, Jevsevar DS, Marx RG, et al. Current status of cost utility analyses in total joint arthroplasty: a systematic review. Clin Orthop Relat Res. 2015b;473(5):1815–27. doi:10.1007/s11999-014-3964-4.CrossRefPubMed

28.

Rongen JJ, Govers TM, Buma P, Grutters JP, Hannink G. Societal and economic effect of meniscus scaffold procedures for irreparable meniscus injuries. Am J Sports Med. 2016;44(7):1724–34. doi:10.1177/0363546516639290.CrossRefPubMed

29.

Moschetti WE, Konopka JF, Rubash HE, Genuario JW. Can robot-assisted unicompartmental knee arthroplasty be cost-effective? A Markov decision analysis. J Arthroplast. 2016;31(4):759–65. doi:10.1016/j.arth.2015.10.018.CrossRef

30.

Nwachukwu BU, McLawhorn AS, Simon MS, Hamid KS, Demetracopoulos CA, Deland JT, et al. Management of end-stage ankle arthritis: cost-utility analysis using direct and indirect costs. J Bone Joint Surg Am. 2015c;97(14):1159–72. doi:10.2106/JBJS.N.01215.CrossRefPubMed

31.

Mather 3rd RC, Garrett WE, Cole BJ, Hussey K, Bolognesi MP, Lassiter T, et al. Cost-effectiveness analysis of the diagnosis of meniscus tears. Am J Sports Med. 2015;43(1):128–37. doi:10.1177/0363546514557937.CrossRefPubMed

32.

Keeney JA, Nunley RM, Adelani M, Mall N. Magnetic resonance imaging of the hip: poor cost utility for treatment of adult patients with hip pain. Clin Orthop Relat Res. 2014;472(3):787–92. doi:10.1007/s11999-013-3431-7.CrossRefPubMed

Title: Technology assessment and cost-effectiveness in orthopedics: how to measure outcomes and deliver value in a constantly changing healthcare environment
Authors: Jeremy M Burnham
Fabien Meta
Vincent Lizzio
Eric C. Makhni
Kevin J Bozic
Publication date: 01-06-2017
Publisher: Springer US
Published in: Current Reviews in Musculoskeletal Medicine / Issue 2/2017
Electronic ISSN: 1935-9748
DOI: https://doi.org/10.1007/s12178-017-9407-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Technology assessment and cost-effectiveness in orthopedics: how to measure outcomes and deliver value in a constantly changing healthcare environment

Abstract

Purpose of review

Recent findings

Summary

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose of review

Recent findings

Summary

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