THE ECONOMIC BURDEN AND HEALTHCARE RESOURCE UTILIZATION OF CLUBFOOT (CONGENITAL TALIPES EQUINOVARUS): A SYSTEMATIC LITERATURE REVIEW
Author(s)
Naresh Goli, MS, Likhitha Guddeti, Pharm D, Madhuri Pullemla, M. Pharmacy.
Evidence Synthesis & HEOR, CliniWings Clinical Research Pvt. Ltd., Hyderabad, India.
Evidence Synthesis & HEOR, CliniWings Clinical Research Pvt. Ltd., Hyderabad, India.
OBJECTIVES: Clubfoot (congenital talipes equinovarus, CTEV) is a prevalent congenital musculoskeletal deformity with significant economic and healthcare resource utilization (HRU) burden, particularly in low- and middle-income countries (LMICs). Although the Ponseti method has transformed management, comprehensive evidence on its economic burden and HRU remains fragmented. This systematic literature review (SLR) synthesized evidence on direct, indirect, and intangible costs, as well as HRU patterns across treatment modalities, age groups, and geographic settings associated with Clubfoot.
METHODS: Following PRISMA 2020, a systematic search was conducted in PubMed/MEDLINE, Cochrane Library, and ClinicalTrials.gov (01 January 2010 to 03 May 2026), supplemented by grey literature from orthopedic conferences and Global/CURE Clubfoot reports (last 5 years). Studies reporting quantitative cost or HRU data for clubfoot were included. Dual independent screening, data extraction, and quality assessment were performed. Narrative synthesis was conducted due to heterogeneity.
RESULTS: Seventy-one studies encompassing >5,000 patients from high-income countries and LMICs were included. Direct medical costs for Ponseti treatment in LMICs ranged from US$55-$349 per patient, substantially lower than traditional surgical approaches (US$452-$1,895). Mean corrective casts ranged from 4-8 in early idiopathic cases versus 9-13 in neglected or complex cases. Bracing was a major cost driver (local splints ~US$25; imported US$350-1,200), with annualized direct costs reaching US$1,127-1,143 per patient. Clinic visits averaged 5-9 per episode, while indirect costs significantly increased societal burden. The Ponseti method consistently demonstrated superior cost-effectiveness versus surgery.
CONCLUSIONS: Clubfoot imposes a considerable economic burden, particularly in resource-limited settings. The Ponseti method is a highly cost-effective and scalable intervention. Standardized, multi-perspective, long-term economic evaluations, especially from Asia-Pacific LMICs, are urgently needed to inform policy, resource allocation, and programmatic implementation.
METHODS: Following PRISMA 2020, a systematic search was conducted in PubMed/MEDLINE, Cochrane Library, and ClinicalTrials.gov (01 January 2010 to 03 May 2026), supplemented by grey literature from orthopedic conferences and Global/CURE Clubfoot reports (last 5 years). Studies reporting quantitative cost or HRU data for clubfoot were included. Dual independent screening, data extraction, and quality assessment were performed. Narrative synthesis was conducted due to heterogeneity.
RESULTS: Seventy-one studies encompassing >5,000 patients from high-income countries and LMICs were included. Direct medical costs for Ponseti treatment in LMICs ranged from US$55-$349 per patient, substantially lower than traditional surgical approaches (US$452-$1,895). Mean corrective casts ranged from 4-8 in early idiopathic cases versus 9-13 in neglected or complex cases. Bracing was a major cost driver (local splints ~US$25; imported US$350-1,200), with annualized direct costs reaching US$1,127-1,143 per patient. Clinic visits averaged 5-9 per episode, while indirect costs significantly increased societal burden. The Ponseti method consistently demonstrated superior cost-effectiveness versus surgery.
CONCLUSIONS: Clubfoot imposes a considerable economic burden, particularly in resource-limited settings. The Ponseti method is a highly cost-effective and scalable intervention. Standardized, multi-perspective, long-term economic evaluations, especially from Asia-Pacific LMICs, are urgently needed to inform policy, resource allocation, and programmatic implementation.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
EE12
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal)