Updating Cost Effectiveness Analyses in Orthopedic Surgery: Resilience of the $50,000 per QALY Threshold.

Abstract

Attention is being paid in the United States (U.S.) to defining and measuring the value of interventions in healthcare. Traditionally, $50,000 per QALY gained has been the accepted "cost-effectiveness threshold" with which cost effectiveness is defined. The validity of this threshold has been called into question largely due to inexact origins; absence of inflationary adjustments and lack of consideration for high gross domestic product of the U.S. There is an opportunity to reassess how we interpret cost utility analyses and the ratios published therein. Orthopedic surgery has typically lagged behind other fields of medicine in self-advocacy and the adoption/implementation of health economic theory. We argue for tiered QALY thresholds of $50,000, $100,000 and $150,000 corresponding respectively to Governmental, Societal and Health systems analysis perspectives.