Health Economics in Pediatric Orthopaedic Surgery
Healthcare expenditures in the United States continue to rise without corresponding improvements in outcomes. Because of this, there is increasing pressure on physicians to consider the economic impact of their medical decisions. Unfortunately, physicians in general are unfamiliar with interpreting and performing various health economic analyses. A basic understanding of health economics may help physicians understand and participate in key policy discussions which may shape the future of medicine and surgery. In the field of pediatric orthopaedics specifically, the literature involving health economic evaluation is sparse. However, many interventions in this field are low cost with potential benefits that accrue over a child's long lifespan. Economic evaluation can help objectively quantify the impact of these interventions, as well as bolster responsible medical decision making. The purpose of this review is to introduce commonly utilized healthcare economic tools including cost-benefit, cost-effectiveness, and cost-utility analyses. We focus on several key concepts including value, quality, time, cost, and discounting. To help illustrate these concepts, health economic literature relevant to pediatric orthopaedics is discussed. Finally, we highlight limitations inherent to health economic evaluations in general and those applicable to pediatric orthopaedics specifically. This discussion may help lay the groundwork for future studies and for further involvement in policy making. Key Concepts: • Healthcare economic evaluations like cost-benefit analysis (CBA), cost-effectiveness analysis (CEA), and costutility analysis (CUA) utilize concepts like value, quality, time, cost, and discounting. • There are unique challenges when performing healthcare economic analyses in the pediatric orthopaedic literature. • An adequate understanding of these concepts may help pediatric orthopaedists to understand and participate in key policy discussions that may shape the future of healthcare.
