{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T16:11:43Z","timestamp":1784304703765,"version":"3.55.0"},"reference-count":27,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2014,4,8]],"date-time":"2014-04-08T00:00:00Z","timestamp":1396915200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2014,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>\nClubfoot is disabling, with an incidence of 0.9\/1,000 live births to 7\/1,000 live births. It affects mobility, productivity, and quality of life. Patients are treated surgically or non\u2010surgically using the Ponseti method. We estimated the cost per patient treated with both methods and the cost\u2010effectiveness of these methods in Pakistan.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Parents of patients treated, either surgically or with the Ponseti method, at the Indus Hospital\u2019s free program for clubfoot were interviewed between February and May 2012. We measured the direct and indirect household expenditures for pre\u2010diagnosis, incomplete treatment, and current treatment until the first brace for Ponseti method and the first corrective surgery for surgically treated patients. Hospital expenditure was measured by existing accounts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Average per\u2010patient cost was $349 for the Ponseti method and $810 for patients treated surgically. Of these, the Indus hospital costs were $170 the for Ponseti method and $452 for surgically treated patients. The direct household expenditure was $154 and $314 for the Ponseti and surgical methods, respectively. The majority of the costs were incurred pre\u2010diagnosis and after inadequate treatment, with the largest proportion spent on transportation, material, and fee for service. The Ponseti method is shown to be the dominant method of treatment, with an incremental cost\u2010effectiveness ratio of $1,225.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The Ponseti method is clearly the treatment of choice in resource\u2010constrained settings like Pakistan. Household costs for clubfoot treatment are substantial, even in programs offering free diagnostics and treatments and may be a barrier to service utilization for the poorest patients.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-014-2530-2","type":"journal-article","created":{"date-parts":[[2014,4,7]],"date-time":"2014-04-07T21:24:26Z","timestamp":1396905866000},"page":"2217-2222","source":"Crossref","is-referenced-by-count":23,"title":["Cost\u2010Effectiveness of the Ponseti Method for Treatment of Clubfoot in Pakistan"],"prefix":"10.1002","volume":"38","author":[{"given":"Hamidah","family":"Hussain","sequence":"first","affiliation":[{"name":"Interactive Research and Development (IRD) Suite 508, Shahrah\u2010e\u2010Faisal, Ibrahim Trade Towers Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aziza Moiz","family":"Burfat","sequence":"additional","affiliation":[{"name":"Indus Hospital Research Center 4th Floor, Indus Hospital, Korangi Crossing Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lubna","family":"Samad","sequence":"additional","affiliation":[{"name":"Indus Hospital Research Center 4th Floor, Indus Hospital, Korangi Crossing Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fayez","family":"Jawed","sequence":"additional","affiliation":[{"name":"Indus Hospital Research Center 4th Floor, Indus Hospital, Korangi Crossing Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Amin","family":"Chinoy","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics &amp; Trauma Indus Hospital Korangi Crossing Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mansoor Ali","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics &amp; Trauma Indus Hospital Korangi Crossing Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,4,8]]},"reference":[{"key":"e_1_2_6_2_2","first-page":"144","article-title":"Club foot in the Maori: a genetic study of 50 kindreds","volume":"88","author":"Beals RK","year":"1978","journal-title":"N Z Med J"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF00195214"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00247\u2010007\u20100581\u20103"},{"key":"e_1_2_6_5_2","volume-title":"World report on disability","author":"WHO","year":"2011"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/BPB.0b013e3283387cc8"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199274030-00021"},{"key":"e_1_2_6_8_2","first-page":"74","article-title":"Correction of the talar neck angle in congenital clubfoot with sequential manipulation and casting","volume":"18","author":"Ponseti IV","year":"1998","journal-title":"Iowa Orthop J"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/BPB.0b013e32826d18a6"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199510000-00002"},{"key":"e_1_2_6_11_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.93B9.26947"},{"key":"e_1_2_6_12_2","first-page":"CD008602","article-title":"Interventions for congenital talipes equinovarus (clubfoot)","volume":"4","author":"Gray K","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_6_13_2","first-page":"83","article-title":"The effect of the internet in the treatment of congenital idiopathic clubfoot","volume":"23","author":"Morcuende JA","year":"2003","journal-title":"Iowa Orthop J"},{"key":"e_1_2_6_14_2","unstructured":"StaheliL MorcuendeJA PiraniS et al (2009)Clubfoot: Ponseti management. 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