Cost-Utility Analyses in US Orthopaedic Foot and Ankle Surgery: A Systematic Review.

BACKGROUND: While investigations have been performed examining the quality of US-based cost-utility analyses for other orthopaedic subspecialties and have provided important insights, a similar analysis has not been performed examining the foot and ankle literature.

METHODS: A systematic review of foot and ankle studies was conducted to identify cost-utility analyses published between 2000 and 2017. Of 687 studies screened by abstract, 4 cost-utility studies were identified and scored by the Quality of Health Economic Studies instrument.

RESULTS: Of these 4 studies, 3 examined end-stage arthritis and 1 examined unstable ankle fractures. Cost-effective interventions identified by these studies included the performance of total ankle arthroplasty over ankle arthrodesis or nonoperative treatment for end-stage arthritis and suture button fixation over syndesmotic screws for unstable supination-external rotation ankle fractures. The mean Quality of Health Economic Studies scores for these studies was 87.5.

CONCLUSION: Despite the increasing focus on value-based care delivery in the United States, there are few foot and ankle cost-utility analyses. Nonetheless, the quality of existing analyses is high. Certain interventions have been identified as cost-effective as highlighted above and the findings of this review can be used to help design future analyses in order to best demonstrate the cost-effectiveness of foot and ankle interventions.

LEVELS OF EVIDENCE: Level III: Systematic Review of level III studies.