Editorial Commentary: Better Care, Better Health, Better Cost: Is Scientific Evidence Negatively Impacting the Transformation of Health Care?

Cost-Effective Medical Care Optimizes Value Over Time

Researchers are encouraged to consider value (cost in addition to outcome) when analyzing the results of arthroscopic and related treatments. Given increasing health care costs, value calculations are critical, particularly in cases of clinical equipoise-uncertainty as to which of various treatment options is optimal. Value calculations must not be shortsighted, and rigor is required to determine direct costs as well as more obscure indirect costs. In addition, sometimes the published literature is ambiguous or conflicting with regard to outcomes. Thus, investigations of cost-effectiveness require sensitivity analyses, where a range of possible results for cost-effectiveness (i.e., the dependent variable) could be reported based on a range of values for the independent variables (costs or outcomes). What is more, value analyses should not be shortsighted; costs and outcomes must be considered over the long term. Ultimately, the most cost-effective treatments may be preferred.

Editorial Commentary: When a Tie Is Still a Win: Systematic Reviews Showing No Difference Between Treatments May Not Be Generalizable to Individual Patients

When a systematic review finds no difference between treatment options for a particular disorder, this could mean more than you think. Individual patients requiring shoulder Bankart repair are unique with respect to their demands and expectations and pathology. Surgeons should combine published principles with understanding of their own skills and their specific patient to optimize a treatment outcome.

Getting Back to Basics: The "Primary" Outcome Measure Determines a Study's Conclusion

In this month's issue, Hollman, Wolterbeek, Zijl, van Egeraat, and Wessel from Nieuwegein, The Netherlands, investigate an essential and most basic concern: how does an abduction brace compare to a simple sling after arthroscopic rotator cuff repair? A criticism of the study, well noted in Editorial Commentary by Kevin Plancher, is that Hollman et al. selected postoperative pain (rather than long-term clinical outcome) as their "primary" outcome measure. The primary outcome measure determines the conclusion of a study. Accurate conclusions require adequate statistical power, particularly if potentially underpowered secondary outcome measures (in this case, long-term clinical outcome) show no difference between 2 treatment options. Research clinicians, patients, and payers comparing abduction brace versus sling after shoulder rotator cuff repair ultimately need to understand if there is a difference in long-term clinical outcomes between the treatment options.