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Orthopaedic Trauma in Low-resource Settings: Measuring Value.

Syed H Ali1, Patrick Albright, Saam Morshed

  • 1Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, San Francisco, CA.

Journal of Orthopaedic Trauma
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PubMed
Summary

Economic data on musculoskeletal trauma care in low- and middle-income countries (LMICs) are scarce. This review highlights cost-effectiveness methods and evidence, emphasizing the need for more research to demonstrate the value of orthopedic trauma interventions.

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Area of Science:

  • Orthopedic Surgery
  • Health Economics
  • Global Health

Background:

  • Trauma care's impact in low- and middle-income countries (LMICs) is recognized, but specific economic data for musculoskeletal trauma are lacking.
  • Economic evaluations are crucial for resource allocation and demonstrating the value of interventions in LMICs.

Purpose of the Study:

  • To review economic analysis methods applicable to low-resource settings for musculoskeletal trauma.
  • To synthesize existing cost studies on orthopedic trauma care in LMICs.
  • To identify research gaps and advocate for rigorous economic evaluations.

Main Methods:

  • Review of economic analysis methodologies (microcosting, societal perspective).
  • Systematic review of cost studies related to orthopedic trauma in LMICs.
  • Analysis of cost-effectiveness metrics (disability-adjusted life years, quality-adjusted life years).

Main Results:

  • Microcosting and a societal perspective are recommended for LMICs due to data limitations.
  • Intramedullary nailing for femoral shaft fractures shows strong economic justification.
  • Trauma care hospitals and educational initiatives are highly cost-effective.
  • Limited economic data exist for other orthopedic trauma interventions.

Conclusions:

  • More rigorous economic analyses are needed to establish the value of musculoskeletal trauma care in LMICs.
  • Orthopedic surgeons should engage with economic evaluation methodologies.
  • Evidence supports specific interventions like intramedullary nailing and broader initiatives like trauma centers.