Nwachukwu Benedict U, Eliasberg Claire D, Hamid Kamran S, Fu Michael C, Bach Bernard R, Allen Answorth A, Albert Todd J
1Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
2Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60612 USA.
HSS J. 2018 Oct;14(3):314-321. doi: 10.1007/s11420-018-9610-z. Epub 2018 Apr 9.
A greater emphasis on providing high-value orthopaedic interventions has resulted in increased health economic reporting. The contingent-valuation method (CVM) is used to determine consumer valuation of the benefits provided by healthcare interventions. CVM is an important value-based health economic tool that is underutilized in orthopaedic surgery.
QUESTIONS/PURPOSES: The purpose of this study was to (1) identify previously published CVM studies in the orthopaedic literature, (2) assess the methodologies used for CVM research, and (3) understand how CVM has been used in the orthopaedic cost-benefit analysis framework.
A systematic review of the literature using the MEDLINE database was performed to compile CVM studies. Search terms incorporated the phrase (WTP) or (WTA) in combination with orthopaedic clinical key terms. Study methodology was appraised using previously defined empirical and conceptual criteria for CVM studies.
Of the 160 studies retrieved, 22 (13.8%) met our inclusion criteria. The economics of joint arthroplasty ( 6, 27.3%) and non-operative osteoarthritis care ( 4, 18.2%) were the most common topics. Most studies used CVM for pricing and/or demand forecasting ( 16, 72.7%); very few studies used CVM for program evaluation ( 6). WTP was used in all included studies, and one study used both WTP and WTA. Otherwise, there was little consistency among included studies in terms of CVM methodology. Open-ended questioning was used by only ten studies (45.5%), a significant number of studies did not perform a sensitivity analysis ( 9, 40.9%), and none of the studies accounted for the risk preference of subjects. Only two of the included studies applied CVM within a cost-benefit analysis framework.
CVM is not commonly reported in orthopaedic surgery and is seldom used in the context of cost-benefit analysis. There is wide variability in the methods used to perform CVM. We propose that CVM is an appropriate and underappreciated method for understanding the value of orthopaedic interventions. Increased attention should be paid to consumer valuations for orthopaedic interventions.
对提供高价值骨科干预措施的更多重视导致了卫生经济报告的增加。条件价值评估法（CVM）用于确定消费者对医疗保健干预措施所提供益处的估值。CVM是一种重要的基于价值的卫生经济工具，但在骨科手术中未得到充分利用。
问题/目的：本研究的目的是（1）识别骨科文献中先前发表的CVM研究，（2）评估用于CVM研究的方法，以及（3）了解CVM在骨科成本效益分析框架中的使用方式。
使用MEDLINE数据库对文献进行系统综述，以汇编CVM研究。检索词包括“支付意愿”（WTP）或“接受意愿”（WTA）短语，并与骨科临床关键词相结合。使用先前为CVM研究定义的实证和概念标准对研究方法进行评估。
在检索到的160项研究中，22项（13.8%）符合我们的纳入标准。关节置换术的经济学（6项，27.3%）和非手术性骨关节炎护理（4项，18.2%）是最常见的主题。大多数研究将CVM用于定价和/或需求预测（16项，72.7%）；很少有研究将CVM用于项目评估（6项）。所有纳入研究均使用了WTP，一项研究同时使用了WTP和WTA。否则，纳入研究在CVM方法方面几乎没有一致性。仅10项研究（45.5%）使用了开放式提问，大量研究未进行敏感性分析（9项，40.9%），且没有一项研究考虑了受试者的风险偏好。纳入研究中只有两项在成本效益分析框架内应用了CVM。
CVM在骨科手术中并不常见，在成本效益分析中很少使用。进行CVM的方法存在很大差异。我们认为CVM是一种理解骨科干预措施价值的合适但未得到充分重视的方法。应更加关注骨科干预措施的消费者估值。
