title: Economic evaluations in shoulder pathologies: a systematic review of the literature.
abstract: BACKGROUND
  Economic evaluations provide decision makers with a tool for reducing health care costs because they assess both the costs and consequences of health care interventions. This study reviewed the quality of published economic evaluations for shoulder pathologies.
  
  
  METHODS
  A MEDLINE search was conducted to identify articles published from 1980 to 2010 that contained "cost" or "economic" combined with terms for several shoulder disorders and treatments. We selected studies that fit the definition of 1 of the 4 routinely performed economic evaluations: cost-minimization, cost-effectiveness, cost-utility, and cost-benefit analyses. Study quality was determined by measuring adherence to 6 established health economic principles, as described in the literature.
  
  
  RESULTS
  The search retrieved 942 studies. Of these, 32 were determined to be economic evaluations, and 53% of the economic evaluations were published from 2005 to 2010. Only 8 of the 32 studies (25%) adhered to all 6 health economic principles. Publication in a nonsurgical journal (P < .05) or in more recent years (P < .01) was significantly associated with higher quality.
  
  
  CONCLUSIONS
  Future health care resource allocation will likely be based on the economic feasibility of treatments. Although the number and quality of economic evaluations of shoulder disorders have risen in recent years, the current state of the literature is poor. Given that availability of such data may factor in private and public reimbursement decisions, there is a clear demand for more rigorous economic evaluations.
authors.affiliation: Harvard Shoulder Service, Department of Orthopedics, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA.
authors.forename: Ifedayo O
authors.initials: IO
authors.lastname: Kuye
authors.forename: Nitin B
authors.initials: NB
authors.lastname: Jain
authors.forename: Lauren
authors.initials: L
authors.lastname: Warner
authors.forename: James H
authors.initials: JH
authors.lastname: Herndon
authors.forename: Jon J P
authors.initials: JJ
authors.lastname: Warner
mesh_terms: D000328:Adult; D000368:Aged; D017046:Cost Savings; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007592:Joint Diseases / Q000191:economics* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D012783:Shoulder Dislocation / Q000000981:diagnostic imaging / Q000191:economics / Q000601:surgery; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000191:economics / Q000601:surgery; D019534:Shoulder Impingement Syndrome / Q000000981:diagnostic imaging / Q000191:economics / Q000601:surgery; D012785:Shoulder Joint / Q000503:physiopathology* / Q000601:surgery; D014481:United States