Economic evaluations in the hip arthroplasty literature - Lessons to be learned

Readers are increasingly encountering articles dealing with health economic evaluations that compare various surgical strategies, leaving orthopaedist s with the challenge of determining which program is cost-efficient and tru ly pertains to their setting. This study carries out a systematic review of the literature to appraise the quality, quantity, and type of economic eva luation as it pertains to the hip arthroplasty literature. To identify all relevant articles, we conducted a comprehensive computerized bibliographic search of Medline from 1966 to 1996. This search produced 1,611 abstracts t hat were screened. Studies that were incorporated met the following inclusi on criteria: i) formal economic analysis, ii) an intervention specific to h ip arthroplasty, and iii) the perspective of the study was evident tie, pat ient, provider, society). These studies were appraised with regards to meth odologic soundness based on 8 established economic principles. Only 68 arti cles from the 138 retrieved met the study criteria. Only 2 of the 68 articl es met all 8 criteria of a comprehensive economic evaluation. The hip arthr oplasty literature is deficient in methodologically sound economic evaluati ons. Several guidelines are introduced to aid orthopaedists in appraising t he various economic studies, and recommendations are made to improve the qu ality of these studies in the orthopaedic literature. We suggest that the g eneration of such information should rank high on the priority list of the orthopaedic profession, granting agencies, and governments.