The Journal of Bone and Joint Surgery (American). 2009;91:73-79.
doi:10.2106/JBJS.H.01537
© 2009 The Journal of Bone and Joint Surgery, Inc.
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Using Observational Data for Decision Analysis and Economic Analysis

Carmen A. Brauer, MD, MSc, FRCSC1 and Kevin J. Bozic, MD, MBA2

1 Division of Orthopedic Surgery, University of Calgary Alberta Children's Hospital, 2888 Shaganappi Trail N.W., Calgary, AB T3B 6A8, Canada
2 Department of Orthopaedic Surgery and Philip R. Lee Institute for Health Policy Studies, 500 Parnassus Avenue, MU320W, San Francisco, CA 94143-0728. E-mail address: bozick{at}orthosurg.ucsf.edu

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Alberta Heritage Foundation for Medical Research. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

In orthopaedic surgery, clinical decisions must often be made with imperfect information from observational studies and limited resources. Decision analysis and cost-effectiveness analysis have emerged as evidence-based tools to assist in making choices in situations in which uncertainty exists. This review demonstrates how decision-analysis and cost-effectiveness-analysis tools can be used to expand on published observational studies within the context of a specific clinical scenario. Critical evaluation of clinical and economic data is of increasing importance in today's health-care delivery climate. The use of decision analysis and cost-effectiveness analysis as tools to augment observational studies can assist clinicians, patients, and policy makers in choosing techniques that will optimize benefits. A clear understanding of and the ability to use and apply these tools will allow surgeons to participate effectively in health-policy decisions to enhance the overall quality and efficiency of care that is delivered.


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