{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T06:11:01Z","timestamp":1789193461783,"version":"build-2803163510"},"reference-count":22,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Economics"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Wydick et\u00a0al. recently estimated the impact of Ponseti clubfoot treatment on human flourishing in Ethiopia, providing important evidence for scaling clubfoot programs in low\u2010 and middle\u2010income countries. However, their definition of \u201ctreated\u201d warrants scrutiny. Considering children in the final stages of casting as treated, only captures outcomes during the early stage of a 4\u2010year treatment course, implicitly assuming full bracing adherence and no relapse. This is inconsistent with relapse rates of 30%\u201340% and two\u2010year discontinuation rates exceeding 50% in comparable settings. This choice of definition likely underestimates late\u2010initiated treatment impact and overestimates early\u2010initiated treatment impact. Modeling the clubfoot care pathway as a probabilistic value model incorporating dropout, non\u2010adherence, and relapse, I re\u2010estimate population\u2010level functional outcomes at mid\u2010childhood. In settings without additional surgical care availability the mean level of functionality is estimated at 55.2% of normal function (95% CI 54.6%\u201355.9%), showing that enrollment expansion alone cannot achieve impact at the scale implied. Achieving clubfoot treatment's full potential at scale requires comprehensive, longitudinal care beyond initial Ponseti treatment, and stronger collaboration between clinical and health\u2010economics communities to ground future estimates in clinical reality.<\/jats:p>","DOI":"10.1002\/hec.70152","type":"journal-article","created":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T06:00:35Z","timestamp":1789192835000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Importance of Treatment Adherence and Long\u2010Term Outcomes in Health Economic Impact Evaluations"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0683-9520","authenticated-orcid":false,"given":"Manon","family":"Pigeolet","sequence":"first","affiliation":[{"name":"Division of Foot and Ankle Surgery Massachusetts General Hospital Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.5435\/JAAOSGLOBAL\u2010D\u201022\u201000022"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1302\/1863\u20102548.12.180117"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0000000000003007"},{"key":"e_1_2_12_5_1","first-page":"15","article-title":"Bracing in the Treatment of Children With Clubfoot: Past, Present, and Future","volume":"30","author":"Desai L.","year":"2010","journal-title":"Iowa Orthopaedic Journal"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18030993"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.106B7.BJJ\u20102023\u20101258.R1"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.101B6.BJJ\u20102018\u20101421.R1"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jposna.2025.100182"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1302\/1863\u20102548.15.210156"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/S12891\u2010022\u201005039\u20109"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.18.216028"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/14737167.2025.2539838"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh\u20102018\u2010000852"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2023.04.005"},{"key":"e_1_2_12_16_1","unstructured":"Pigeolet M.2025a. \u201cDoes Increased Cast Change Interval During Ponseti Treatment Increase the Risk for Dropout From Treatment in Low\u2010Resource Settings? Conclusions From the \u2018Ponseti Adherence Inadvertent Outcomes and Relapse Clubfoot Study\u2019 (PAIR Clubfoot Study) (Podium Presentation).\u201d Manchester International Clubfoot Conference."},{"key":"e_1_2_12_17_1","unstructured":"Pigeolet M.2025b. \u201cIncreasing Adherence to Clubfoot Treatment in South Asia[ULB].\u201dhttp:\/\/hdl.handle.net\/2013\/."},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/S00264\u2010021\u201005058\u20106"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/S43465\u2010022\u201000748\u20108"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999\u2010009\u20100720\u20102"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/BMJGH\u20102024\u2010017861"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0277\u20109536(99)00045\u20103"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/hec.70040"}],"container-title":["Health Economics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hec.70152","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/hec.70152","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hec.70152","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T06:00:37Z","timestamp":1789192837000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hec.70152"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,11]]},"references-count":22,"alternative-id":["10.1002\/hec.70152"],"URL":"https:\/\/doi.org\/10.1002\/hec.70152","archive":["Portico"],"relation":{},"ISSN":["1057-9230","1099-1050"],"issn-type":[{"value":"1057-9230","type":"print"},{"value":"1099-1050","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,11]]},"assertion":[{"value":"2026-03-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"hec.70152"}}