Updating Cost Effectiveness Analyses in Orthopedic Surgery: Resilience of the $50,000 per QALY Threshold.

UNLABELLED: Attention is being paid in the United States (U.S.) to defining and measuring the value of interventions in healthcare. Traditionally, $50,000 per QALY gained has been the accepted "cost-effectiveness threshold" with which cost effectiveness is defined. The validity of this threshold has been called into question largely due to inexact origins; absence of inflationary adjustments and lack of consideration for high gross domestic product of the U.S. POPULATION: There is an opportunity to reassess how we interpret cost utility analyses and the ratios published therein. Orthopedic surgery has typically lagged behind other fields of medicine in self-advocacy and the adoption/implementation of health economic theory. We argue for tiered QALY thresholds of $50,000, $100,000 and $150,000 corresponding respectively to Governmental, Societal and Health systems analysis perspectives.