Abstract:
BACKGROUND:Cost-effectiveness research is an increasingly used tool in evaluating treatments in orthopaedic surgery. Without high-quality primary-source data, the results of a cost-effectiveness study are either unreliable or heavily dependent on sensitivity analyses of the findings from the source studies. However, to our knowledge, the strength of recommendations provided by these studies in orthopaedics has not been studied. QUESTIONS/PURPOSES:We asked: (1) What are the strengths of recommendations in recent orthopaedic cost-effectiveness studies? (2) What are the reasons authors cite for weak recommendations? (3) What are the methodologic reporting practices used by these studies? METHODS:The titles of all articles published in six different orthopaedic journals from January 1, 2004, through April 1, 2014, were scanned for original health economics studies comparing two different types of treatment or intervention. The full texts of included studies were reviewed to determine the strength of recommendations determined subjectively by our study team, with studies providing equivocal conclusions stemming from a lack or uncertainty surrounding key primary data classified as weak and those with definitive conclusions not lacking in high-quality primary data classified as strong. The reasons underlying a weak designation were noted, and methodologic practices reported in each of the studies were examined using a validated instrument. A total of 79 articles met our prespecified inclusion criteria and were evaluated in depth. RESULTS:Of the articles included, 50 (63%) provided strong recommendations, whereas 29 (37%) provided weak recommendations. Of the 29 studies, clinical outcomes data were cited in 26 references as being insufficient to provide definitive conclusions, whereas cost and utility data were cited in 13 and seven articles, respectively. Methodologic reporting practices varied greatly, with mixed adherence to framing, costs, and results reporting. The framing variables included clearly defined intervention, adequate description of a comparator, study perspective clearly stated, and reported discount rate for future costs and quality-adjusted life years. Reporting costs variables included economic data collected alongside a clinical trial or another primary source and clear statement of the year of monetary units. Finally, results reporting included whether a sensitivity analysis was performed. CONCLUSIONS:Given that a considerable portion of orthopaedic cost-effectiveness studies provide weak recommendations and that methodologic reporting practices varied greatly among strong and weak studies, we believe that clinicians should exercise great caution when considering the conclusions of cost-effectiveness studies. Future research could assess the effect of such cost-effectiveness studies in clinical practice, and whether the strength of recommendations of a study's conclusions has any effect on practice patterns. CLINICAL RELEVANCE:Given the increasing use of cost-effectiveness studies in orthopaedic surgery, understanding the quality of these studies and the reasons that limit the ability of studies to provide more definitive recommendations is critical. Highlighting the heterogeneity of methodologic reporting practices will aid clinicians in interpreting the conclusions of cost-effectiveness studies and improve future research efforts.
journal_name
Clin Orthop Relat Resjournal_title
Clinical orthopaedics and related researchauthors
Makhni EC,Steinhaus ME,Swart E,Bozic KJdoi
10.1007/s11999-015-4369-8subject
Has Abstractpub_date
2015-10-01 00:00:00pages
3289-96issue
10eissn
0009-921Xissn
1528-1132journal_volume
473pub_type
杂志文章abstract:BACKGROUND:Heterotopic ossification (HO) is a common extrinsic cause of elbow stiffness after trauma. However, factors associated with the development of HO are incompletely understood. QUESTIONS/PURPOSES:We retrospectively identified (1) patient-related demographic factors, (2) injury-related factors, and (3) treatme...
journal_title:Clinical orthopaedics and related research
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abstract::A computer-assisted model has been developed to improve the results of surgical techniques for reconstruction of hip dysplasia. This method assesses the coverage and congruency of the femoral head by evaluating multiple factors that may influence surgical planning. It achieves a more reliable image because the measure...
journal_title:Clinical orthopaedics and related research
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abstract:BACKGROUND:Patients with severe lower extremity trauma have significant disability 2 years after injury that worsens by 7 years. Up to 15% seek late amputation. Recently, an energy-storing orthosis demonstrated improved function compared with standard orthoses; however, the effect when integrated with rehabilitation ov...
journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1984-03-01 00:00:00
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journal_title:Clinical orthopaedics and related research
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abstract::Recurrent dislocation of the elbow with paradoxical dislocation of the ulnar nerve complicated by neuropathy may occur from avulsion of the lateral epicondyle and laxity of the collateral ligaments. In a 22-year-old man, the injury was successfully treated by plication of the collateral ligaments. The nerve dislocatio...
journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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