Updating Cost Effectiveness Analyses in Orthopedic Surgery: Resilience of the $50,000 per QALY Threshold

The Journal of Arthroplasty
Benedict U Nwachukwu, Kevin J Bozic

Abstract

Attention is being paid in the United States (U.S.) to defining and measuring the value of interventions in healthcare. Traditionally, $50,000 per QALY gained has been the accepted "cost-effectiveness threshold" with which cost effectiveness is defined. The validity of this threshold has been called into question largely due to inexact origins; absence of inflationary adjustments and lack of consideration for high gross domestic product of the U.S. There is an opportunity to reassess how we interpret cost utility analyses and the ratios published therein. Orthopedic surgery has typically lagged behind other fields of medicine in self-advocacy and the adoption/implementation of health economic theory. We argue for tiered QALY thresholds of $50,000, $100,000 and $150,000 corresponding respectively to Governmental, Societal and Health systems analysis perspectives.

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Citations

Feb 7, 2016·The Bone & Joint Journal·F S Haddad, A S McLawhorn
Mar 13, 2016·Journal of Shoulder and Elbow Surgery·Benedict U NwachukwuLawrence V Gulotta
Apr 5, 2016·Journal of Surgical Oncology·Daniel E AbbottJeffrey J Sussman
Apr 5, 2016·Journal of Surgical Oncology·Daniel E Abbott
May 31, 2015·Clinical Orthopaedics and Related Research·Eric C MakhniKevin J Bozic
May 4, 2017·The Journal of Bone and Joint Surgery. American Volume·Brian T BarlowGeoffrey H Westrich
Jan 7, 2017·The Journal of Bone and Joint Surgery. American Volume·Eric SwartMadhav Karunakar
Oct 3, 2018·The Journal of Bone and Joint Surgery. American Volume·Gregory S KazarianAntonia F Chen
Jun 21, 2018·Foot & Ankle Specialist·Aditya V Karhade, John Y Kwon
Oct 10, 2019·Journal of Orthopaedic Trauma·Dylan L McCrearyBrian P Cunningham
Oct 10, 2019·The Journal of Bone and Joint Surgery. American Volume·Kwan J ParkStephen J Incavo
May 1, 2019·The American Journal of Sports Medicine·Joshua S EverhartDavid C Flanigan
Dec 5, 2019·The Journal of Bone and Joint Surgery. American Volume·Kwan J ParkStephen J Incavo
May 4, 2017·The American Journal of Sports Medicine·Benedict U NwachukwuEmily R Dodwell
May 22, 2020·Orthopaedic Journal of Sports Medicine·Thomas TischerChristoph Lutter
Aug 28, 2020·Hip International : the Journal of Clinical and Experimental Research on Hip Pathology and Therapy·Philip J RosinskyBenjamin G Domb
Mar 30, 2017·Neurosurgery·Scott L ParkerMatthew J McGirt
Aug 5, 2017·The Bone & Joint Journal·H ChawlaH M Ghomrawi
Feb 6, 2020·HSS Journal : the Musculoskeletal Journal of Hospital for Special Surgery·Jayme C B KoltsovBenedict U Nwachukwu
Apr 2, 2019·JDR Clinical and Translational Research·D D SkaarK M Kuntz
Jul 23, 2020·The Journal of the American Academy of Orthopaedic Surgeons·David R MaldonadoBenjamin G Domb
Apr 13, 2020·The Journal of Arthroplasty·Ajay PremkumarBenedict U Nwachukwu
Jun 18, 2021·JDR Clinical and Translational Research·K M KuntzD D Skaar
Aug 15, 2021·Journal of Shoulder and Elbow Surgery·Kelsey L WiseBrian P Cunningham

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