Affecting more than half of adults in the U.S., low back pain, osteoarthritis and musculoskeletal trauma are the three most common musculoskeletal conditions leading to emergency department and physician visits and hospital stays. Nearly $800 billion, or about 5 percent of the U.S. economy, goes towards diagnosing, treating, and managing musculoskeletal conditions.


Elena Losina, PhD

“America spends more money on managing musculoskeletal conditions than it does on Social Security benefits for retired persons and their families,” said Elena Losina, PhD, professor of Orthopedic Surgery at BWH’s Department of Orthopedic Surgery and Harvard Medical School. “As people live longer and baby boomers age, this burden will increase.”

To help address these issues, BWH has launched the Policy and Innovation eValuation in Orthopedic Treatments (PIVOT) Center in the Department of Orthopedic Surgery. The research conducted by the PIVOT Center will help policy makers, physicians and patients to maximize treatment health benefits while reducing the overall economic burden of musculoskeletal diseases.

The mission of the center is to use multidisciplinary research methods to inform the development of innovative procedures and improve the clinical and economic value of existing procedures. By establishing the value of technologic innovations in orthopedics and disseminating evidence that informs treatment policy and care, the center aims to serve as a national hub for health policy research in orthopedics and musculoskeletal disorders.

Losina will lead the PIVOT Center as its founding director. Losina is a principal investigator of the NIH-funded Osteoarthritis Policy Model, which is designed to investigate the long-term clinical and economic impact of knee osteoarthritis and its treatment.

“Elena Losina is recognized internationally for her expertise in chronic disease modeling, cost-effectiveness analyses and for melding rigorous clinical research methodologies across multiple clinical disciplines, from orthopedics and osteoarthritis to global health,” said James Kang, MD, chair of the Department of Orthopedic Surgery. “I am thrilled that she will be spearheading this new initiative.”

PIVOT Center faculty will use innovative modeling methods that project findings of clinical research into long-term gains in quality-adjusted life expectancy for people with musculoskeletal diseases. The research conducted at the PIVOT Center will guide clinicians and policy makers in their efforts to reduce pain and disability and improve quality of life for people with musculoskeletal conditions.

“PIVOT will facilitate implementation of value-based orthopedic care delivery,” said Losina. “Ideally, treatment strategies for musculoskeletal disorders would be evaluated in large randomized trials. Such trials can only be conducted over short periods of time and at substantial cost. Model-based analyses overcome these challenges. Insurers, pharmaceutical companies and government agencies are recognizing the pivotal role of model-based evaluations. We live in an era of limited resources, and the primary goal of the PIVOT Center is to optimize the use of these resources by promoting value-based care that improves the well-being of patients.”

One of the key directions of the PIVOT Center’s work will be to use decision analysis modeling to help prioritize future clinical research and inform the research agenda of the Orthopedic and Arthritis Center for Outcomes Research (OrACORe).

“The health care system faces unprecedented pressures, and the PIVOT Center will help us meet these challenges,” said Jeffrey Katz, MD, director of Research at the Department of Orthopedic Surgery, Clement Sledge and Thomas Thornhill Chair in Orthopedic Surgery, and Director of OrACORe. “The research conducted at the PIVOT Center will complement the research agenda of OrACORe.”

The initial clinical areas of the PIVOT Center will be the low extremities and lumbar spine. The center will use the Osteoarthritis Policy (OAPol) model, a computer simulation model of knee osteoarthritis, to address critical questions about the value of total knee replacement in persons with comorbidities, including morbid obesity and diabetes as well as some types of cancer. In addition, the center will work on developing a new model called FACETS (Finding Appropriate Cost-Effective Treatments for the Spine) that will focus on defining the value for surgical and non-surgical treatments for patients with lumbar spinal stenosis, disc problems and degenerative spondylolisthesis.

“The center has tremendous utility for all stakeholders in health care and policy, and will help us optimize the value of care we provide for our patients,” said Kang. “The research conducted by the center will attract the best fellows and residents by providing them an opportunity to learn methods of health policy evaluation and collaborate with internationally renowned experts.”