Current Orthopaedic Health Economic Literature: Quality is High but Ethical and Societal Perspectives are Lacking

ABSTRACT Purpose To evaluate the quality of orthopaedic cost-effectiveness analyses (CEAs) in accordance with the 2016 recommendations by the Second Panel on Cost-Effectiveness in Health and Medicine. Methods A systematic review of all CEAs from 9/2017-9/2019 in the ten highest impact orthopaedic surgery journals was performed. Quality scoring utilized the Quality of Health Economic Studies (QHES) instrument and the Second Panel checklist. QHES scores ≥80 were considered to be high quality and Results The 10 highest impact orthopaedic journals published 6,323 articles with 35 (0.55%) meeting inclusion criteria. Total joint arthroplasty (TJA) and sports medicine articles comprised 65.7% of included studies. Overall mean QHES score was 89.0±7.6, with 82.8% considered high quality. Mean proportion of Second Panel checklist items fulfilled was 82.1±13.3%, but no studies performed an impact inventory accounting for consequences within and outside the healthcare sector or discussed ethical implications. Mean QHES score and satisfied checklist items were significantly different by journal (p=0.025 and p=0.01, respectively). Additionally, there was a moderate positive correlation between QHES score and impact factor (r=0.446, p=0.007). TJA CEAs satisfied a higher number of checklist items compared to spine surgery CEAs. Conclusions Recent orthopaedic CEAs have generally been high quality according to updated Second Panel guidelines, but consistently miss checklist items relating to societal impact and ethics. TJA and sports medicine continue to be the most frequently studied orthopaedic subspecialties in health economics, and the breadth of orthopaedic procedures analyzed by CEAs has improved. Study Design Level IV, systematic review