There is an important matter that the paper does not consider or overlooks: and that is the economic aspect of unnecessary operations.
Let us, for the sake of argument, grant that unnecessary operations are more expensive than intensive physical therapy. (After operation, patients have some physical therapy anyway.) Do these operations increase or decrease the Gross Domestic Product? The GDP is defined as “the market value of all officially recognized final goods and services produced within a country in a given period of time.” (I quote from Wikipedia.)
At first sight they do. As everyone knows, operations are not cheap. Without them, the GDP would fall. So would the incomes of those who perform them – orthopaedic surgeons, for example, and all their hangers-on such as operating room nurses. Presumably their incomes have a multiplier effect, for example on the legal profession.
On the other hand, there are the opportunity costs of employing money in this rather futile, indeed counterproductive, manner. But would the money in fact be better employed elsewhere? Would not something just as unproductive be done with it? These, surely, are unanswerable questions, being so entirely hypothetical.
And so what this paper titled “Surgery versus Physical Therapy for Meniscal Tear and Osteoarthitis” (which, incidentally, has 29 authors) really establishes is that the GDP is a more or less useless measure of economic output, to say nothing of human welfare. Of course, further research is needed: that should increase GDP a little. Or should it?
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