The cost of healthcare in the United States and throughout the world has been increasing at an alarming pace. Total national health expenditures rose by almost eight percent in 2003 and health care spending in the United States reached $ 1.7 trillion which was more than four times the amount spent on national defense. The Medicare program in the United States is the secondlargest social insurance program, with 42 million beneficiaries and total expenditures of $ 309 billion in 2004. One of the principal drivers in health care costs is new technology. Cost utility studies of new technology are scarce and somewhat lacking. Most surgical subspecialties are eagerly embracing new technologies as soon as it becomes available. Computer-Assisted Orthopaedic Surgery (CAOS) has received significant attention in the orthopaedic literature. Development and validation of navigation systems has also been the subject of several publications. It is clear from this literature that these systems help surgeons improve accuracy of implant placement and diminish the variance between procedures. The cost of a navigation system in the U.S. today varies from $ 55,000 to over $ 300,000 (see . Table 8.2). At the time of this writing, the food and drug administration (FDA) panel has approved 14 systems, (. Table 8.1) and more than 16 commercial firms in the United States sell or lease the computer equipment and instruments used for computer-assisted orthopaedic surgery. An exhaustive search of the following databases including Medline, Co-chrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effectiveness (DARE), Cochrane Controlled Trial Register, HealthSTAR, NHS Economic Evaluation Database (AMED), relevant audit databases, and the Worldwide Web demonstrated no published articles on the cost utility of CAOS. These searches were performed in a structured fashion utilizing electronic databases and relevant audit databases between 1998 and 2006, using free text terms to identify papers that evaluated the cost utility or cost effectiveness of CAOS. A few papers casually mentioned the costs of these technologies in their methodology. Hip and knee arthroplasty has clearly been shown to be cost effective by a number of authors in several countries. The most commonly utilized technique to measure cost effectiveness is the cost utility ratio. This ratio involves the calculation of the impact of a specific intervention on the patient quality of life as well as the costs of that technology intervention. This ratio is then utilized to calculate what the costs per quality year for that particular intervention. Any new or additional expense that the surgeon or industry brings forward must be added on. The total cost must be factored in a calculation of further increases in quality adjusted well years. CAOS faces a significant hurdle as the current cost effectiveness of total hip and total knee arthroplasty is impressive without this new technology.
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