Resource allocation in orthopaedics: economic evaluation to priority setting

In 2000 the World Health Organization launched the "Bone and Joint Decade" campaign in part to promote cost-effective treatments. This will impact the organization, delivery, and funding of health care as the population ages. However, it is well recognized that resources in health care are limited and it is essential the resources available are used to best effect. Thus, there has been greater emphasis in the orthopaedic literature on the use of economics. Still, there is little discussion of whether and how the results of these economic methods can be further used to aid resource allocation decisions. We discuss the suitability of economic methods for priority setting in orthopaedic surgery, arguing economic evaluation alone is not sufficient for addressing resource allocation decisions. We also describe an alternative approach to priority setting that has been steadily gaining prominence within health economics--program budgeting and marginal analysis--and use a working example from the United Kingdom National Health Service to illustrate its application within orthopaedic surgery.