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DOI: 10.1055/s-0029-1185714
Eine Einführung in Methoden der ökonomischen Evaluation für Orthopäden und Unfallchirurgen
Introduction to Methods of Economic Modelling: A Primer for Orthopaedic Surgeons and TraumatologistsPublication History
Publication Date:
30 June 2009 (online)
![](https://www.thieme-connect.de/media/zfo/200904/lookinside/thumbnails/10.1055-s-0029-1185714-1.jpg)
Zusammenfassung
Studienziel: Gesundheitsökonomie und Kosteneffizienz sind stetig präsente Themen in der Orthopädie und Unfallchirurgie der Gegenwart. Diese Thematik wird jedoch fast ausschließlich von Ökonomen und Politikern geprägt, unter weitgehendem Ausschluss der Ärzteschaft. Dies wird zumeist mit mangelnden Kenntnissen begründet. Diese Arbeit soll klinisch tätigen Orthopäden und Unfallchirurgen die Grundzüge der ökonomischen Evaluation näherbringen, um eine aufgeklärte Diskussion zu erleichtern. Methode: In dieser Arbeit wird ein Überblick über die Grundlagen der ökonomischen Evaluation und Hintergrundwissen zu deren Anwendung in Orthopädie und Unfallchirurgie geboten. Ergebnisse: Ökonomische Evaluation betrachtet Kosten und Konsequenzen medizinischer Tätigkeit. Partielle Evaluationen betrachten lediglich Kosten, während komplette Analysen Konsequenzen in verschiedener Form inkludieren. Kosten-Effektivitäts-Analysen beziehen Kosten auf Effektivität im Sinne von z. B. gewonnenen Lebensjahren oder zusätzlicher Beweglichkeit, während Kosten-Nutzwert-Analysen qualitätskorrigierte Lebensjahre als Summe verschiedener Effekte einschließen. Zuletzt bleiben die Kosten-Nutzen-Analysen, welche Konsequenzen als Geldwert darstellen. Details zu Durchführung und Problempotenzial werden dargestellt. Es zeigt sich, dass zu orthopädischen und unfallchirurgischen Themen vor allem Kosten-Nutzwert-Analysen durchgeführt werden, aber dass deren Anzahl und Qualität, wenn auch im Steigen begriffen, unzureichend ist, um zu klaren Empfehlungen zu gelangen. Schlussfolgerung: Ökonomische Evaluationen für Orthopädie und Unfallchirurgie werden in Zukunft vermehrt gefordert werden. Die Vermittlung relevanter Grundkenntnisse an klinisch tätige Orthopäden und Unfallchirurgen und der Einschluss solcher Personen in ökonomische Studien wäre von großem Vorteil für Ärzteschaft und Patienten.
Abstract
Aim: Health economics and cost-efficiency are ubiquitously present issues in present day orthopaedic surgery. These subjects, however, are almost exclusively dealt with by economists and policy makers, while medical professionals rarely take part, quite often because of insufficient methodological knowledge. This report presents the basics of economic evaluation to orthopaedic surgeons to facilitate informed discussion. Method: This text reviews the basic methodology of economic evaluation and pertinent findings for orthopaedic surgery. Results: Economic evaluation combines costs and consequences of medical treatments. Partial analyses study costs only, while complete studies include different parameters of consequence. Cost-effectiveness analysis sets cost and effectiveness in natural metrics in relation, while cost-utility analyses present consequences as quality-adjusted life years. Cost-benefit analyses translate both costs and consequences into money value and thus produce a net benefit. Orthopaedic research focuses mainly on cost-utility analyses, yet their number and quality, despite both have been rising over the last years, are mostly insufficient to come to unequivocal conclusions or to produce clear recommendations. Conclusion: The trend for an increasing demand for economic evaluations in orthopaedic surgery will continue unabated. Both patients and medical professionals would benefit if orthopaedic surgeons received instruction in economic evaluations in order to be able to take part in such studies or to meaningfully discuss such matters.
Schlüsselwörter
ökonomische Evaluation - Kosteneffektivität - Kosten‐Nutzwert‐Analyse - Kosten‐Nutzen‐Analyse
Key words
economic modelling - cost‐effectiveness - cost‐utility - cost‐benefit
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Dr. MD Patrick Vavken
Department of Orthopedic Surgery
Children's Hospital Boston, Harvard Medical School
300 Longwood Ave
Boston, MA 02115
United States
Email: patrick.vavken@childrens.harvard.edu