HSS Journal ®

, Volume 14, Issue 3, pp 314–321 | Cite as

Contingent Valuation Studies in Orthopaedic Surgery: A Health Economic Review

  • Benedict U. Nwachukwu
  • Claire D. Eliasberg
  • Kamran S. Hamid
  • Michael C. Fu
  • Bernard R. Bach
  • Answorth A. Allen
  • Todd J. Albert
Review Article



A greater emphasis on providing high-value orthopaedic interventions has resulted in increased health economic reporting. The contingent-valuation method (CVM) is used to determine consumer valuation of the benefits provided by healthcare interventions. CVM is an important value-based health economic tool that is underutilized in orthopaedic surgery.


The purpose of this study was to (1) identify previously published CVM studies in the orthopaedic literature, (2) assess the methodologies used for CVM research, and (3) understand how CVM has been used in the orthopaedic cost–benefit analysis framework.


A systematic review of the literature using the MEDLINE database was performed to compile CVM studies. Search terms incorporated the phrase willingness to pay (WTP) or willingness to accept (WTA) in combination with orthopaedic clinical key terms. Study methodology was appraised using previously defined empirical and conceptual criteria for CVM studies.


Of the 160 studies retrieved, 22 (13.8%) met our inclusion criteria. The economics of joint arthroplasty (n = 6, 27.3%) and non-operative osteoarthritis care (n = 4, 18.2%) were the most common topics. Most studies used CVM for pricing and/or demand forecasting (n = 16, 72.7%); very few studies used CVM for program evaluation (n = 6). WTP was used in all included studies, and one study used both WTP and WTA. Otherwise, there was little consistency among included studies in terms of CVM methodology. Open-ended questioning was used by only ten studies (45.5%), a significant number of studies did not perform a sensitivity analysis (n = 9, 40.9%), and none of the studies accounted for the risk preference of subjects. Only two of the included studies applied CVM within a cost–benefit analysis framework.


CVM is not commonly reported in orthopaedic surgery and is seldom used in the context of cost–benefit analysis. There is wide variability in the methods used to perform CVM. We propose that CVM is an appropriate and underappreciated method for understanding the value of orthopaedic interventions. Increased attention should be paid to consumer valuations for orthopaedic interventions.


contingent valuation method cost–benefit analysis cost-effectiveness analysis willingness to pay 


Compliance with Ethical Standards

Conflict of Interest

Benedict U. Nwachukwu, MD, MBA, Claire D. Eliasberg, MD, Kamran S. Hamid, MD, MPH, Michael C. Fu, MD, MHS, Bernard R. Bach, MD, and Answorth A. Allen, MD, declare that they have no conflicts of interest. Todd J. Albert, MD, reports royalties from DePuy Synthes and Facet Link; investment interest in Biomerix, Crosstrees Medical, Gentis, International Orthopaedic Alliance, InVivo Therapeutics, Invuity, Paradigm Spine, Pulse Equity, and Spinicity; stock options in Vital 5; personal fees from Zimmer Biomet and Lineum Cervical System and Polaris Spinal System; and medical advisory board membership at United Healthcare, outside the submitted work.

Human/Animal Rights


Informed Consent


Required Author Forms:

Disclosure forms provided by the authors are available with the online version of this article.

Supplementary material

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Copyright information

© Hospital for Special Surgery 2018

Authors and Affiliations

  • Benedict U. Nwachukwu
    • 1
  • Claire D. Eliasberg
    • 1
  • Kamran S. Hamid
    • 2
  • Michael C. Fu
    • 1
  • Bernard R. Bach
    • 2
  • Answorth A. Allen
    • 1
  • Todd J. Albert
    • 1
  1. 1.Department of Orthopaedic SurgeryHospital for Special SurgeryNew YorkUSA
  2. 2.Department of Orthopaedic SurgeryRush University Medical CenterChicagoUSA

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