Medico-Economic and Medico-Social Evaluation of Two Types of Treatment for Clubfoot in France: A Prospective Study Using a Mixed Methods Approach

Background/Objectives: Congenital clubfoot is the most frequent malformation in pediatric orthopedics. In France, two treatments can be proposed: the Ponseti method and the functional method. The objective was to conduct a medico-economic and -social evaluation of those methods. Methods: Medico-economic: a cost-consequences analysis was undertaken from the societal perspective, based on the Dimeglio score at 24 months in four pediatric hospitals. Medico-social: interviews were conducted with parents (n = 16) and healthcare professionals (n = 16). Results: One hundred patients were included between January 2014 and December 2016. Whatever the treatment method, over 90% of patients presented with benign clubfoot (i.e., Dimeglio score < 5/20) at 24 months, based on multiply imputed estimates. The Functional method was associated with higher direct medical and non-medical costs (€3340–4061 vs. 889–2318; €6275–5968 vs. 576–726), and indirect costs (€15,441–4672 vs. 1416–1786), contrary to out-of-pocket expenses (€0–1 vs. €322–546). Family testimonies underscored the importance of communication from healthcare providers to reassure and guide parents. Although the choice is influenced by professionals, trust and active engagement of families are essential for adherence to treatment and its long-term success. The Ponseti method combined effectiveness with a lower perceived burden for families. Conclusions: The Ponseti method was the costliest for parents, yet more manageable. However, the most important factor is to choose a method adapted to the family in order to achieve the best degree of compliance.