Orthopaedic devices deliver important clinical benefits to
patients cost effectively
31 October 2012
Joint research by the European Health Technology Institute for
Socio-Economic Research (EHTI), London School of Economics, Centre for
health Economics and the University of York, has been published looking
into the socioeconomic value of orthopaedic devices.
Published in the journal Orthopedic Research and Reviews,
the study investigated the impact on clinical and economic outcomes
and identified the methodological challenges that arise when
assessing the full value of technological advances in orthopaedic
The systematic review identified 33 economic evaluations
published between 1996 and 2008 of which 19 related to hip-specific
devices with the remaining evaluations relating mainly to knee
joints and hip protectors.
Multiple endpoints were used to assess the clinical outcome. In
49% the outcomes were combined into a single generic measure, the
quality adjusted life year (QALY) frequently used in cost-utility
analysis. The evidence suggests that the select orthopaedic devices
deliver important benefits to patients by increasing their mobility,
improving their functional status and enhancing their health-related
quality of life (including pain or sleep for example).
Decreased risk of ill health and improved mobility resulted
in a mean QALY gain of 0.02 (range 0.007-0.04) and other health
related quality of life measures on average an increase of 2.01
(range -0.02 – 6.88) QALY.
In the context of hip protectors, the evidence also suggests that
their use reduces the risk of fracture. For the economic outcome,
the vast majority adopted a payer or hospital perspective, focusing
on direct health care cost. Only one study adopted a broader
The study also demonstrates that these devices achieve these
benefits at good value for money, and for hip protectors, with cost
savings ($68-$230 per person). Value for money continued to be
demonstrated for evaluation across all technology types with maximum
value attained when orthopaedic devices were used in populations
with a greater baseline risk of fracture, in women at earlier age
with most benefit at age 75-80, demonstrating that the main question
is not one of whether orthopaedic devices deliver economic value,
but the circumstances in which they do so.
The research also identified the methodological challenges in
assessing the full value. Different from pharmaceutical products,
there is a rapid evolution in medical technology addressing initial
limitation and providing further clinical improvements. Also the way
to use and implant these technologies changes over time ie the
learning curve, and implementation of new more effective procedures
and use of healthcare resources all impact the ultimate value.
“Consideration of the technological advances and their impact on
clinical and socio-economic outcomes is of major importance as
decision-makers are starting to require formal evaluation of medical
devices for decisions regarding resource allocation, said Yves
Verboven, Executive Director EHTI.
The publication is available at