title: Redefining the Economics of Geriatric Orthopedics.
abstract: BACKGROUND
  The heath care system in the United States is in the midst of a transition, in large part to help accommodate an older and more medically complex population. Central to the current evolution is the reassessment of value based on the cost utility of a particular procedure compared to alternatives. The existing contribution of geriatric orthopedics to the societal burden of disease is substantial, and literature focusing on the economic value of treating elderly populations with musculoskeletal injuries is growing.
  
  
  METHODS
  A literature review of peer-reviewed publications and abstracts related to the cost-effectiveness of treating geriatric patients with orthopedic injuries was carried out.
  
  
  RESULTS
  In our review, we demonstrate that while cost-utility studies generally demonstrate net society savings for most orthopedic procedures, geriatric populations often contribute to negative net society savings due to decreased working years and lower salaries while in the workforce. However, the incremental cost-effective ratio for operative intervention has been shown to be below the financial willingness to treat threshold for common procedures including joint replacement surgery of the knee (ICER US$8551), hip (ICER US$17 115), and shoulder (CE US$957) as well as for spinal procedures and repair of torn rotator cuffs (ICER US$12 024). We also discuss the current trends directed toward improving institutional value and highlight important complementary next steps to help overcome the growing demands of an older, more active society.
  
  
  CONCLUSIONS
  The geriatric population places a significant burden on the health care system. However, studies have shown that treating this demographic for orthopedic-related injuries is cost effective and profitable for providers under certain scenarios.
authors.affiliation: Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Truntzer
authors.affiliation: Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Nacca
authors.affiliation: Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, USA.
authors.forename: David
authors.initials: D
authors.lastname: Paller
authors.affiliation: Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, USA.
authors.forename: Alan H
authors.initials: AH
authors.lastname: Daniels
keywords: QALY; cost utility; economic value; geriatric orthopedics; orthopedic procedures