The Hand Surgery Landscape| Volume 48, ISSUE 3, P301-306, March 2023

Download started.


Understanding Health Economics in Hand Surgery

Published:January 06, 2023DOI:
      Rising health care costs in the United States, besides evolving payment models that place emphasis on value instead of volume, have led to an increasing number of studies evaluating hand surgery from an economic perspective. To better understand such economics-based studies, this review provides a foundational understanding of what value entails by defining its features of quality and cost. Principles of evaluating value through cost-benefit, cost-effectiveness, and cost-utility analyses are discussed. Models of discounting and clinical decision analyses are also discussed. Understanding such concepts and their evaluation in economic analyses will provide greater insight into the economic landscape of hand surgery and improving patient care.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Fajardo M.
        • Kim S.H.
        • Szabo R.M.
        Incidence of carpal tunnel release: trends and implications within the United States ambulatory care setting.
        J Hand Surg Am. 2012; 37: 1599-1605
        • Dieleman J.
        • Squires E.
        • Bui A.
        • et al.
        Factors associated with increases in US health care spending, 1996-2013.
        J Am Med Assoc. 2017; 318: 1668-1678
        • Miller D.J.
        • Throckmorton T.W.
        • Azar F.M.
        • Beaty J.H.
        • Canale S.T.
        • Richardson D.R.
        Business and practice management knowledge deficiencies in graduating orthopedic residents.
        Am J Orthop. 2015; 44: E373-E378
        • Prieto L.
        • Sacristán J.A.
        Problems and solutions in calculating quality-adjusted life years (QALYs).
        Health Qual Life Outcomes. 2003; 19: 80
        • Bozic K.J.
        • Rosenberg A.G.
        • Huckman R.S.
        • Herndon J.H.
        Economic evaluation in orthopedics.
        J Bone Jt Surg Am. 2003; 85: 129-142
        • Hoang-Kim A.
        • Pegreffi F.
        • Moroni A.
        • Ladd A.
        Measuring wrist and hand function: common scales and checklists.
        Injury. 2011; 42: 253-258
        • Garza A.G.
        • Wyrwich K.W.
        Health utility measures and the standard gamble.
        Acad Emerg Med. 2003; 10: 360-363
        • Morimoto T.
        • Fukui T.
        Utilities measured by rating scale, time trade-off, and standard gamble: review and reference for healthcare professionals.
        J Epidemiol. 2002; 12: 160-178
        • Li Y.K.
        • Alolabi N.
        • Kaur M.N.
        • Thoma A.
        A systematic review of utilities in hand surgery literature.
        J Hand Surg. 2015; 40: 997-1005
      1. Agency for Healthcare Research and Quality, Types of healthcare quality measures.
        • Okura C.
        • Ishikawa H.
        • Abe A.
        • et al.
        Long-term patient-reported outcomes of elbow, wrist, and hand surgery for rheumatoid arthritis.
        Int J Rheum Dis. 2018; 21: 1701-1708
        • Pike J.
        • Grosse S.D.
        Friction cost estimates of productivity costs in cost-of-illness studies in comparison with human capital estimates: a review.
        Appl Health Econ Health Policy. 2018; 16: 765-778
        • Haacker M.
        • Hallett T.B.
        • Atun R.
        On discount rates for economic evaluations in global health.
        Health Policy Plan. 2020; 35: 107-114
      2. Making choices in health: WHO guide to cost-effectiveness analysis.
        Revista Española de Salud Pública. 2004; 78
        • Rajan P.V.
        • Qudsi R.A.
        • Dyer G.S.M.
        • Losina E.
        The cost-effectiveness of surgical fixation of distal radial fractures: a computer model-based evaluation of three operative modalities.
        J Bone Jt Surg Am. 2018; 100: 1-13
        • Song J.W.
        • Chung K.C.
        • Prosser L.A.
        Treatment of ulnar neuropathy at the elbow: cost-utility analysis.
        J Hand Surg. 2012; 37: 1617-1629
        • Bertram M.Y.
        • Lauer J.A.
        • De Joncheere K.
        • et al.
        Cost-effectiveness thresholds: pros and cons.
        Bull World Health Organ. 2016; 94: 925-930
        • Tadisina K.K.
        • Chopra K.
        • Tangredi J.
        • Thomson J.G.
        • Singh D.P.
        Helping hands: a cost-effectiveness study of a humanitarian hand surgery mission.
        Plast Int Surg. 2014; 2014921625
        • Snyder K.J.G.
        • Amaral S.
        • Kessler S.
        • et al.
        Pediatric hand transplantation: a decision analysis.
        Hand. 2021; 16: 731-740
        • Hogendoorn W.
        • Moll F.L.
        • Sumpio B.E.
        • Hunink M.G.M.
        Clinical decision analysis and Markov modeling for surgeons: an introductory overview.
        Ann Surg. 2016; 264: 268-274