title: Cost-effectiveness analyses in orthopaedic sports medicine: a systematic review.
abstract: BACKGROUND
  As increasing attention is paid to the cost of health care delivered in the United States (US), cost-effectiveness analyses (CEAs) are gaining in popularity. Reviews of the CEA literature have been performed in other areas of medicine, including some subspecialties within orthopaedics. Demonstrating the value of medical procedures is of utmost importance, yet very little is known about the overall quality and findings of CEAs in sports medicine.
  
  
  OBJECTIVE
  To identify and summarize CEA studies in orthopaedic sports medicine and to grade the quality of the available literature.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  A systematic review of the literature was performed to compile findings and grade the methodological quality of US-based CEA studies in sports medicine. The Quality of Health Economic Studies (QHES) instrument and the checklist by the US Panel on Cost-effectiveness in Health and Medicine were used to assess study quality. One-sided Fisher exact testing was performed to analyze the predictors of high-quality CEAs.
  
  
  RESULTS
  Twelve studies met inclusion criteria. Five studies examined anterior cruciate ligament reconstruction, 3 studies examined rotator cuff repair, 2 examined autologous chondrocyte implantation, 1 study examined hip arthroscopic surgery, and 1 study examined the operative management of shoulder dislocations. Based on study findings, operative intervention in sports medicine is highly cost-effective. The quality of published evidence is good, with a mean quality score of 81.8 (range, 70-94). There is a trend toward higher quality in more recent publications. No significant predictor of high-quality evidence was found.
  
  
  CONCLUSIONS
  The CEA literature in sports medicine is good; however, there is a paucity of studies, and the available evidence is focused on a few procedures. More work needs to be conducted to quantify the cost-effectiveness of different techniques and procedures within sports medicine. The QHES tool may be useful for the evaluation of future CEAs.
authors.affiliation: Hospital for Special Surgery, New York, New York, USA nwachukwub@hss.edu.
authors.forename: Benedict U
authors.initials: BU
authors.lastname: Nwachukwu
authors.affiliation: Hospital for Special Surgery, New York, New York, USA.
authors.forename: William W
authors.initials: WW
authors.lastname: Schairer
authors.affiliation: Weill Medical College of Cornell University, Ithaca, New York, USA.
authors.forename: Jaime L
authors.initials: JL
authors.lastname: Bernstein
authors.affiliation: Hospital for Special Surgery, New York, New York, USA.
authors.forename: Emily R
authors.initials: ER
authors.lastname: Dodwell
authors.affiliation: Hospital for Special Surgery, New York, New York, USA.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Marx
authors.affiliation: Hospital for Special Surgery, New York, New York, USA.
authors.forename: Answorth A
authors.initials: AA
authors.lastname: Allen
mesh_terms: D001265:Athletic Injuries / Q000191:economics* / Q000601:surgery; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care; D017048:Health Care Costs; D006801:Humans; D019637:Orthopedic Procedures / Q000191:economics*; D013178:Sports Medicine / Q000191:economics*; D014481:United States
keywords: Quality of Health Economic Studies; anterior cruciate ligament; autologous chondrocyte implantation; cost-effectiveness analysis; rotator cuff repair