Orthopaedic devices deliver important clinical benefits to patients cost effectively

31 October 2012

Joint research by the European Health Technology Institute for Socio-Economic Research (EHTI), London School of Economics, Centre for health Economics and the University of York, has been published looking into the socioeconomic value of orthopaedic devices.

Published in the journal Orthopedic Research and Reviews, the study investigated the impact on clinical and economic outcomes and identified the methodological challenges that arise when assessing the full value of technological advances in orthopaedic devices.

The systematic review identified 33 economic evaluations published between 1996 and 2008 of which 19 related to hip-specific devices with the remaining evaluations relating mainly to knee joints and hip protectors.

Multiple endpoints were used to assess the clinical outcome. In 49% the outcomes were combined into a single generic measure, the quality adjusted life year (QALY) frequently used in cost-utility analysis. The evidence suggests that the select orthopaedic devices deliver important benefits to patients by increasing their mobility, improving their functional status and enhancing their health-related quality of life (including pain or sleep for example).

 Decreased risk of ill health and improved mobility resulted in a mean QALY gain of 0.02 (range 0.007-0.04) and other health related quality of life measures on average an increase of 2.01 (range -0.02 – 6.88) QALY.

In the context of hip protectors, the evidence also suggests that their use reduces the risk of fracture. For the economic outcome, the vast majority adopted a payer or hospital perspective, focusing on direct health care cost. Only one study adopted a broader societal perspective.

The study also demonstrates that these devices achieve these benefits at good value for money, and for hip protectors, with cost savings ($68-$230 per person). Value for money continued to be demonstrated for evaluation across all technology types with maximum value attained when orthopaedic devices were used in populations with a greater baseline risk of fracture, in women at earlier age with most benefit at age 75-80, demonstrating that the main question is not one of whether orthopaedic devices deliver economic value, but the circumstances in which they do so.

The research also identified the methodological challenges in assessing the full value. Different from pharmaceutical products, there is a rapid evolution in medical technology addressing initial limitation and providing further clinical improvements. Also the way to use and implant these technologies changes over time ie the learning curve, and implementation of new more effective procedures and use of healthcare resources all impact the ultimate value. “Consideration of the technological advances and their impact on clinical and socio-economic outcomes is of major importance as decision-makers are starting to require formal evaluation of medical devices for decisions regarding resource allocation, said Yves Verboven, Executive Director EHTI.

More information

The publication is available at www.ehti.eu