Custo-efetividade da telemedicina no acompanhamento de asmáticos: revisão sistemática

2019 ◽  
Vol 17 (2) ◽  
Author(s):  
Marcela Da Silva Souza ◽  
Carolina Barbosa Souza Santos ◽  
Raimeyre Marques Torres ◽  
Mayara Sousa Silva ◽  
Ana Carla Carvalho Coelho ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Cost Effectiveness ◽  
Asthma Management ◽  
Review Of The Literature ◽  
Eligibility Criteria ◽  
The Cost ◽  
Made In

Aim: systematic review of the literature on the cost-effectiveness of telemedicine in the follow-up of asthmatics. Method: Systematic review of the PUBMED / MEDLINE, LILACS and Cochrane Central databases. Articles published in English, Portuguese or Spanish were considered in the period from 2005 to 2018 according to the PRISMA guidelines. Results: A total of 1363 articles were identified, of which 59 were read in their entirety. Only five met the eligibility criteria, and all were made in European countries and totaled 2,497 participants. The interventions were performed by nurses (4 of 5 studies), remaining from 16 weeks to 12 months. Telemedicine costs were similar or slightly lower compared to usual treatments. Telemedicine had a beneficial effect on asthma control (1 of 5 studies), quality of life (3 out of 5 studies) and hospitalizations (1 of 5 studies). Conclusion: Telemedicine slightly reduces costs with asthma management and may have an impact on morbidity indicators

scholarly journals Integrated sensor-augmented pump therapy systems [the MiniMed® Paradigm™ Veo system and the Vibe™ and G4® PLATINUM CGM (continuous glucose monitoring) system] for managing blood glucose levels in type 1 diabetes: a systematic review and economic evaluation

2016 ◽  
Vol 20 (17) ◽  
pp. 1-252 ◽  
Author(s):  
Rob Riemsma ◽  
Isaac Corro Ramos ◽  
Richard Birnie ◽  
Nasuh Büyükkaramikli ◽  
Nigel Armstrong ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Type 1 Diabetes ◽  
Cost Effectiveness ◽  
Glucose Monitoring ◽  
Cost Effective ◽  
Over Time

BackgroundIn recent years, meters for continuous monitoring of interstitial fluid glucose have been introduced to help people with type 1 diabetes mellitus (T1DM) to achieve better control of their disease.ObjectiveThe objective of this project was to summarise the evidence on the clinical effectiveness and cost-effectiveness of the MiniMed®Paradigm™ Veo system (Medtronic Inc., Northridge, CA, USA) and the Vibe™ (Animas®Corporation, West Chester, PA, USA) and G4®PLATINUM CGM (continuous glucose monitoring) system (Dexcom Inc., San Diego, CA, USA) in comparison with multiple daily insulin injections (MDIs) or continuous subcutaneous insulin infusion (CSII), both with either self-monitoring of blood glucose (SMBG) or CGM, for the management of T1DM in adults and children.Data sourcesA systematic review was conducted in accordance with the principles of the Centre for Reviews and Dissemination guidance and the National Institute for Health and Care Excellence Diagnostic Assessment Programme manual. We searched 14 databases, three trial registries and two conference proceedings from study inception up to September 2014. In addition, reference lists of relevant systematic reviews were checked. In the absence of randomised controlled trials directly comparing Veo or an integrated CSII + CGM system, such as Vibe, with comparator interventions, indirect treatment comparisons were performed if possible.MethodsA commercially available cost-effectiveness model, the IMS Centre for Outcomes Research and Effectiveness diabetes model version 8.5 (IMS Health, Danbury, CT, USA), was used for this assessment. This model is an internet-based, interactive simulation model that predicts the long-term health outcomes and costs associated with the management of T1DM and type 2 diabetes. The model consists of 15 submodels designed to simulate diabetes-related complications, non-specific mortality and costs over time. As the model simulates individual patients over time, it updates risk factors and complications to account for disease progression.ResultsFifty-four publications resulting from 19 studies were included in the review. Overall, the evidence suggests that the Veo system reduces hypoglycaemic events more than other treatments, without any differences in other outcomes, including glycated haemoglobin (HbA1c) levels. We also found significant results in favour of the integrated CSII + CGM system over MDIs with SMBG with regard to HbA1clevels and quality of life. However, the evidence base was poor. The quality of the included studies was generally low, often with only one study comparing treatments in a specific population at a specific follow-up time. In particular, there was only one study comparing Veo with an integrated CSII + CGM system and only one study comparing Veo with a CSII + SMBG system in a mixed population. Cost-effectiveness analyses indicated that MDI + SMBG is the option most likely to be cost-effective, given the current threshold of £30,000 per quality-adjusted life-year gained, whereas integrated CSII + CGM systems and Veo are dominated and extendedly dominated, respectively, by stand-alone, non-integrated CSII with CGM. Scenario analyses did not alter these conclusions. No cost-effectiveness modelling was conducted for children or pregnant women.ConclusionsThe Veo system does appear to be better than the other systems considered at reducing hypoglycaemic events. However, in adults, it is unlikely to be cost-effective. Integrated systems are also generally unlikely to be cost-effective given that stand-alone systems are cheaper and, possibly, no less effective. However, evidence in this regard is generally lacking, in particular for children. Future trials in specific child, adolescent and adult populations should include longer term follow-up and ratings on the European Quality of Life-5 Dimensions scale at various time points with a view to informing improved cost-effectiveness modelling.Study registrationPROSPERO Registration Number CRD42014013764.FundingThe National Institute for Health Research Health Technology Assessment programme.

scholarly journals Impact and cost-effectiveness of care farms on health and well-being of offenders on probation: a pilot study

2018 ◽  
Vol 6 (3) ◽  
pp. 1-190 ◽  
Author(s):  
Helen Elsey ◽  
Rachel Bragg ◽  
Marjolein Elings ◽  
Cathy Brennan ◽  
Tracey Farragher ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Cost Effectiveness ◽  
Pilot Study ◽  
Primary Outcome ◽  
Well Being ◽  
Propensity Analysis ◽  
Future Work

Background Care farms (CFs), in which all or part of the farm is used for therapeutic purposes, show potential for improving well-being for disadvantaged groups. We assessed the feasibility of determining the cost-effectiveness of CFs in improving quality of life compared with comparator sites among probationers undertaking community orders (COs). Objectives (1) To conduct a systematic review of CF impacts and mechanisms in improving health and logic model development; (2) to inform future studies by estimating differences in quality of life and other outcomes, identifying factors driving CO allocation and ways to maximise recruitment and follow-up; and (3) to assess feasibility of cost-effectiveness analysis. Review methods A mixed-methods synthesis following Campbell Collaboration guidelines. Pilot study: three probation service regions in England, each with a CF and a comparator CO site. Participants were adult offenders (aged ≥ 18 years) serving COs. The primary outcome was quality of life [as measured via the Clinical Outcome in Routine Evaluation–Outcome Measure (CORE-OM)]. Other outcomes were health behaviours, mental well-being, connectedness to nature and reconvictions. Data sources In November 2014, we searched 22 health, education, environmental, criminal justice and social science electronic databases, databases of grey literature and care farming websites across Europe. There were no language restrictions. A full list of databases searched is given in Appendix 1; some examples include Web of Science, Cumulative Index to Nursing and Allied Health Literature (via EBSCOhost), The Campbell Library, Criminal Justice Abstracts (via EBSCOhost), MEDLINE (via Ovid) and Scopus (Elsevier B.V., Amsterdam, the Netherlands). Results Our systematic review identified 1659 articles: 14 qualitative, 12 quantitative and one mixed-methods study. Small sample sizes and poor design meant that all were rated as being at a high risk of bias. Components of CFs that potentially improve health are being in a group, the role of the farmer and meaningful work, and interaction with animals. There was a lack of quantitative evidence indicating that CFs improve quality of life and there was weak evidence of improved mental health, self-efficacy, self-esteem, affect and mood. In the pilot study we recruited 134 respondents, and only 21 declined; 37% were allocated to three CFs and the remainder to comparators. This was below our recruitment target of 300. Recruitment proved challenging as a result of the changes in probation (probation trusts were disbanded in 2014) and closure of one CF. We found significant differences between CFs and comparator users: those at CFs were more likely to be male, smokers, substance users, at higher risk of reoffending (a confounder) and have more missing CORE-OM questions. Despite these differences, the use of propensity analysis facilitated comparison. Participants consented to our team accessing, and we were able to link, probation and police reconviction data for 90% of respondents. We gained follow-up questionnaire data from 52% of respondents, including health and social care use cost data. We transformed CORE-OM into CORE-6D, allowing derivation of quality-adjusted life-years. As a pilot, our study was not powered to identify significant differences in outcomes. Qualitatively, we observed that within COs, CFs can be formally recognised as rehabilitative but in practice can be seen as punitive. Limitations Changes in probation presented many challenges that limited recruitment and collection of cost data. Conclusions Recruitment is likely to be feasible in a more stable probation environment. Retention among probationers is challenging but assessing reconvictions from existing data is feasible. We found worse health and risk of reoffending among offenders at CFs, reflecting the use of CFs by probation to manage challenging offenders. Future work A sufficiently powered natural experiment is feasible and of value. Using reconvictions (from police data) as a primary outcome is one solution to challenges with retention. Propensity analysis provides a viable method for comparison despite differences in participants at CFs and comparator sites. However, future work is dependent on stability and support for CFs within probation services. Study registration This study is registered as PROSPERO CRD42014013892 and SW2013–04 (the Campbell Collaboration). Funding details The National Institute for Health Research Public Health Research programme.

scholarly journals Interventions for hyperhidrosis in secondary care: a systematic review and value-of-information analysis

2017 ◽  
Vol 21 (80) ◽  
pp. 1-280 ◽  
Author(s):  
Ros Wade ◽  
Stephen Rice ◽  
Alexis Llewellyn ◽  
Eoin Moloney ◽  
Julie Jones-Diette ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Cost Effectiveness ◽  
Secondary Care ◽  
Value Of Information ◽  
Cost Effective ◽  
Axillary Hyperhidrosis ◽  
Primary Hyperhidrosis ◽  
The Cost

BackgroundHyperhidrosis is uncontrollable excessive sweating that occurs at rest, regardless of temperature. The symptoms of hyperhidrosis can significantly affect quality of life. The management of hyperhidrosis is uncertain and variable.ObjectiveTo establish the expected value of undertaking additional research to determine the most effective interventions for the management of refractory primary hyperhidrosis in secondary care.MethodsA systematic review and economic model, including a value-of-information (VOI) analysis. Treatments to be prescribed by dermatologists and minor surgical treatments for hyperhidrosis of the hands, feet and axillae were reviewed; as endoscopic thoracic sympathectomy (ETS) is incontestably an end-of-line treatment, it was not reviewed further. Fifteen databases (e.g. CENTRAL, PubMed and PsycINFO), conference proceedings and trial registers were searched from inception to July 2016. Systematic review methods were followed. Pairwise meta-analyses were conducted for comparisons between botulinum toxin (BTX) injections and placebo for axillary hyperhidrosis, but otherwise, owing to evidence limitations, data were synthesised narratively. A decision-analytic model assessed the cost-effectiveness and VOI of five treatments (iontophoresis, medication, BTX, curettage, ETS) in 64 different sequences for axillary hyperhidrosis only.Results and conclusionsFifty studies were included in the effectiveness review: 32 randomised controlled trials (RCTs), 17 non-RCTs and one large prospective case series. Most studies were small, rated as having a high risk of bias and poorly reported. The interventions assessed in the review were iontophoresis, BTX, anticholinergic medications, curettage and newer energy-based technologies that damage the sweat gland (e.g. laser, microwave). There is moderate-quality evidence of a large statistically significant effect of BTX on axillary hyperhidrosis symptoms, compared with placebo. There was weak but consistent evidence for iontophoresis for palmar hyperhidrosis. Evidence for other interventions was of low or very low quality. For axillary hyperhidrosis cost-effectiveness results indicated that iontophoresis, BTX, medication, curettage and ETS was the most cost-effective sequence (probability 0.8), with an incremental cost-effectiveness ratio of £9304 per quality-adjusted life-year. Uncertainty associated with study bias was not reflected in the economic results. Patients and clinicians attending an end-of-project workshop were satisfied with the sequence of treatments for axillary hyperhidrosis identified as being cost-effective. All patient advisors considered that the Hyperhidrosis Quality of Life Index was superior to other tools commonly used in hyperhidrosis research for assessing quality of life.LimitationsThe evidence for the clinical effectiveness and safety of second-line treatments for primary hyperhidrosis is limited. This meant that there was insufficient evidence to draw conclusions for most interventions assessed and the cost-effectiveness analysis was restricted to hyperhidrosis of the axilla.Future workBased on anecdotal evidence and inference from evidence for the axillae, participants agreed that a trial of BTX (with anaesthesia) compared with iontophoresis for palmar hyperhidrosis would be most useful. The VOI analysis indicates that further research into the effectiveness of existing medications might be worthwhile, but it is unclear that such trials are of clinical importance. Research that established a robust estimate of the annual incidence of axillary hyperhidrosis in the UK population would reduce the uncertainty in future VOI analyses.Study registrationThis study is registered as PROSPERO CRD42015027803.FundingThe National Institute for Health Research Health Technology Assessment programme.

scholarly journals Cost-effectiveness of point-of-care viscoelastic haemostatic assays in the management of bleeding during cardiac surgery: protocol for a prospective multicentre pragmatic study with stepped-wedge cluster randomised controlled design and 1-year follow-up (the IMOTEC study)

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e029751 ◽  
Author(s):  
Jean-Christophe Rigal ◽  
Elodie Boissier ◽  
Karim Lakhal ◽  
Valéry-Pierre Riche ◽  
Isabelle Durand-Zaleski ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cardiac Surgery ◽  
Cost Effectiveness ◽  
Point Of Care ◽  
Stepped Wedge ◽  
Cluster Randomised ◽  
Randomised Controlled ◽  
The Cost

IntroductionDuring cardiac surgery-associated bleeding, the early detection of coagulopathy is crucial. However, owing to time constraints or lack of suitable laboratory tests, transfusion of haemostatic products is often inappropriately triggered, either too late (exposing to prolonged bleeding and thus to avoidable administration of blood products) or blindly to the coagulation status (exposing to unnecessary haemostatic products administration in patients with no coagulopathy). Undue exposition to transfusion risks and additional healthcare costs may arise. With the perspective of secondary care-related costs, the IMOTEC study (Intérêt MédicO-économique de la Thrombo-Elastographie, dans le management transfusionnel des hémorragies péri-opératoires de chirurgies Cardiaques sous circulation extracorporelle) aims at assessing the cost-effectiveness of a point-of-care viscoelastic haemostatic assay (VHA: RoTem or TEG)-guided management of bleeding. Among several outcome measures, particular emphasis will be put on quality of life with a 1-year follow-up.Methods and analysisThis is a multicentre, prospective, pragmatic study with stepped-wedge cluster randomised controlled design. Over a 36-month period (24 months of enrolment and 12 months of follow-up), 1000 adult patients undergoing cardiac surgery with cardiopulmonary bypass will be included if a periprocedural significant bleeding occurs. The primary outcome is the cost-effectiveness of a VHA-guided algorithm over a 1-year follow-up, including patients’ quality of life. Secondary outcomes are the cost-effectiveness of the VHA-guided algorithm with regard to the rate of surgical reexploration and 1-year mortality, its cost per-patient, its effectiveness with regard to haemorrhagic, infectious, renal, neurological, cardiac, circulatory, thrombotic, embolic complications, transfusion requirements, mechanical ventilation free-days, duration of intensive care unit and in-hospital stay and mortality.Ethics and disseminationThe study was registered at Clinicaltrials.gov and was approved by the Committee for the Protection of Persons of Nantes University Hospital, The French Advisory Board on Medical Research Data Processing and the French Personal Data Protection Authority. A publication of the results in a peer-reviewed journal is planned.Trial registration numberNCT02972684; Pre-results.

Psychological and Cognitive Aspects of Borderline Intellectual Functioning

2017 ◽  
Vol 22 (3) ◽  
pp. 159-166 ◽  
Author(s):  
Bastianina Contena ◽  
Stefano Taddei
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Intellectual Functioning ◽  
Clinical Impact ◽  
Review Of The Literature ◽  
Borderline Intellectual Functioning ◽  
General Quality ◽  
Meta Analyses ◽  
Over Time

Abstract. Borderline Intellectual Functioning (BIF) refers to a global IQ ranging from 71 to 84, and it represents a condition of clinical attention for its association with other disorders and its influence on the outcomes of treatments and, in general, quality of life and adaptation. Furthermore, its definition has changed over time causing a relevant clinical impact. For this reason, a systematic review of the literature on this topic can promote an understanding of what has been studied, and can differentiate what is currently attributable to BIF from that which cannot be associated with this kind of intellectual functioning. Using Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) criteria, we have conducted a review of the literature about BIF. The results suggest that this condition is still associated with mental retardation, and only a few studies have focused specifically on this condition.

scholarly journals Women in surgery: a systematic review of 25 years

BMJ Leader ◽  
2020 ◽  
pp. leader-2019-000199
Author(s):  
Charleen Singh ◽  
Caitlin Loseth ◽  
Noordeen Shoqirat
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Work Life ◽  
Current Status ◽  
Leadership Roles ◽  
Review Of The Literature ◽  
Life Balance ◽  
Surgical Residency ◽  
Meta Analyses

The number of women entering medicine significantly increased over the last decades. Currently, over half of the medical students are women but less than half are applying to surgery and even less go on to surgical specialties. Even fewer women are seen in leadership roles throughout the profession of surgery and surgical residency. Our purpose of the literature review is to identify any themes, which would provide insight to the current phenomenon. We used the Preferred Reporting Items for Systemic Reviews and Meta-Analyses method for a systematic review of the literature over a 20-year period (1998–2018). Five broad themes were identified: education and recruitment, career development, impact of/on life around the globe and surgical subspecialties as areas of barriers for women entering or considering surgery. The systematic review suggests there are opportunities to improve and encourage women entering the profession of surgery as well as the quality of life for surgeons. Creating systems for mentorship across programmes, having policies to support work–life balance and recognising surgical training overlaps with childbearing years are key opportunities for improvement. Improving the current status in surgery will require direction from leadership.

scholarly journals An assessment of the use of patient reported outcome measurements (PROMs) in cancers of the pelvic abdominal cavity: identifying oncologic benefit and an evidence-practice gap in routine clinical practice

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Miss Charlotte L. Moss ◽  
Ajay Aggarwal ◽  
Asad Qureshi ◽  
Benjamin Taylor ◽  
Teresa Guerrero-Urbano ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Abdominal Cavity ◽  
Patient Reported Outcome ◽  
Oncologic Outcomes ◽  
Review Of The Literature ◽  
Outcome Measurements ◽  
Patient Reported ◽  
Cancer Setting

Abstract Background Patient reported outcome measurements (PROMs) are emerging as an important component of patient management in the cancer setting, providing broad perspectives on patients’ quality of life and experience. The use of PROMs is, however, generally limited to the context of randomised control trials, as healthcare services are challenged to sustain high quality of care whilst facing increasing demand and financial shortfalls. We performed a systematic review of the literature to identify any oncological benefit of using PROMs and investigate the wider impact on patient experience, in cancers of the pelvic abdominal cavity specifically. Methods A systematic review of the literature was conducted using MEDLINE (Pubmed) and Ovid Gateway (Embase and Ovid) until April 2020. Studies investigating the oncological outcomes of PROMs were deemed suitable for inclusion. Results A total of 21 studies were included from 2167 screened articles. Various domains of quality of life (QoL) were identified as potential prognosticators for oncologic outcomes in cancers of the pelvic abdominal cavity, independent of other clinicopathological features of disease: 3 studies identified global QoL as a prognostic factor, 6 studies identified physical and role functioning, and 2 studies highlighted fatigue. In addition to improved outcomes, a number of included studies also reported that the use of PROMs enhanced both patient-clinician communication and patient satisfaction with care in the clinical setting. Conclusions This review highlights the necessity of routine collection of PROMs within the pelvic abdominal cancer setting to improve patient quality of life and outcomes.

scholarly journals A Systematic Review of the Cost-Effectiveness of Nurse Practitioners and Clinical Nurse Specialists: What Is the Quality of the Evidence?

2014 ◽  
Vol 2014 ◽  
pp. 1-28 ◽  
Author(s):  
Faith Donald ◽  
Kelley Kilpatrick ◽  
Kim Reid ◽  
Nancy Carter ◽  
Ruth Martin-Misener ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Nurse Practitioners ◽  
Internal Validity ◽  
Risk Of Bias ◽  
Nurse Specialist ◽  
Clinical Nurse ◽  
Education Experience ◽  
The Cost

Background. Improved quality of care and control of healthcare costs are important factors influencing decisions to implement nurse practitioner (NP) and clinical nurse specialist (CNS) roles.Objective. To assess the quality of randomized controlled trials (RCTs) evaluating NP and CNS cost-effectiveness (defined broadly to also include studies measuring health resource utilization).Design. Systematic review of RCTs of NP and CNS cost-effectiveness reported between 1980 and July 2012.Results. 4,397 unique records were reviewed. We included 43 RCTs in six groupings, NP-outpatient (n=11), NP-transition (n=5), NP-inpatient (n=2), CNS-outpatient (n=11), CNS-transition (n=13), and CNS-inpatient (n=1). Internal validity was assessed using the Cochrane risk of bias tool; 18 (42%) studies were at low, 17 (39%) were at moderate, and eight (19%) at high risk of bias. Few studies included detailed descriptions of the education, experience, or role of the NPs or CNSs, affecting external validity.Conclusions. We identified 43 RCTs evaluating the cost-effectiveness of NPs and CNSs using criteria that meet current definitions of the roles. Almost half the RCTs were at low risk of bias. Incomplete reporting of study methods and lack of details about NP or CNS education, experience, and role create challenges in consolidating the evidence of the cost-effectiveness of these roles.

scholarly journals Cost-Effectiveness of Hip Arthroscopy for Treatment of Femoroacetabular Impingement Syndrome and Labral Tears: A Systematic Review

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712098753
Author(s):  
Cammille C. Go ◽  
Cynthia Kyin ◽  
Jeffrey W. Chen ◽  
Benjamin G. Domb ◽  
David R. Maldonado
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Nonoperative Treatment ◽  
Cochrane Library ◽  
System Perspective ◽  
Labral Tears ◽  
The Cost

Background: Hip arthroscopy has frequently been shown to produce successful outcomes as a treatment for femoroacetabular impingement (FAI) and labral tears. However, there is less literature on whether the favorable results of hip arthroscopy can justify the costs, especially when compared with a nonoperative treatment. Purpose: To systematically review the cost-effectiveness of hip arthroscopy for treating FAI and labral tears. Study Design: Systematic review; Level of evidence, 3. Methods: PubMed/MEDLINE, Embase, and Cochrane Library databases, and the Tufts University Cost-Effectiveness Analysis Registry were searched to identify articles that reported the cost per quality-adjusted life-year (QALY) generated by hip arthroscopy. The key terms used were “hip arthroscopy,” “cost,” “utility,” and “economic evaluation.” The threshold for cost-effectiveness was set at $50,000/QALY. The Methodological Index for Non-Randomized Studies instrument and Quality of Health Economic Studies (QHES) score were used to determine the quality of the studies. This study was prospectively registered on PROSPERO (CRD42020172991). Results: Six studies that reported the cost-effectiveness of hip arthroscopy were identified, and 5 of these studies compared hip arthroscopy to a nonoperative comparator. These studies were found to have a mean QHES score of 85.2 and a mean cohort age that ranged from 33-37 years. From both a health care system perspective and a societal perspective, 4 studies reported that hip arthroscopy was more costly but resulted in far greater gains than did nonoperative treatment. The preferred treatment strategy was most sensitive to duration of benefit, preoperative osteoarthritis, cost of the arthroscopy, and the improvement in QALYs with hip arthroscopy. Conclusion: In the majority of the studies, hip arthroscopy had a higher initial cost but provided greater gain in QALYs than did a nonoperative treatment. In certain cases, hip arthroscopy can be cost-effective given a long enough duration of benefit and appropriate patient selection. However, there is further need for literature to analyze willingness-to-pay thresholds.

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