April 17, 2020
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Implant cost may correlate with total inpatient cost after TJA

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Published results showed variation in total inpatient cost between different subspecialties of arthroplasty, with implant cost found to be the main driver of cost variation.

Andrew Jawa
Andrew Jawa

Andrew Jawa, MD, and colleagues implemented time-driven activity-based costing at the New England Baptist Hospital from 2015 to 2018 to calculate the cost of the episode of inpatient care for 22,215 total joint arthroplasties, including total knee arthroplasty, total hip arthroplasty, anatomic total shoulder arthroplasty, reverse total shoulder arthroplasty, total elbow arthroplasty and total ankle arthroplasty. Researchers analyzed implant price, supply costs, personnel costs and length of stay for each procedure, and compared individual cost parameters with total cost and volume.

Results showed a correlation between high implant costs and higher total costs, representing 53.8% of the total cost for an inpatient care cycle. According to Jawa, TKA and THA procedures had the lowest implant prices, which he noted is likely due to overall industry volume.

“We do far more hip and knee replacements than shoulder and elbow replacements, so over an order of magnitude, and that was reflected on implant prices being much lower,” Jawa, of the New England Baptist Hospital and Boston Sports and Shoulder Center, told Healio Orthopedics.

He added that reverse shoulder arthroplasty and total ankle arthroplasty had the highest implant costs, which likely reflects a smaller industry volume.

“For a knee replacement, [implant cost] was about 40% of the overall cost, while a reverse shoulder replacement was almost 65%, so there is significant variation in ... what percentage that implant is of overall cost,” Jawa said.

Although length of stay correlated with increased personnel cost, researchers noted it had no significant effect on total cost.

“Length of stay had a marginal impact and implant cost was the main driver [of overall cost],” Jawa said. – by Casey Tingle

 

Disclosures: Jawa reports he is a consultant for DonJoy Orthopedics and a designer for Ignite Orthopedics. Please see the study for all other authors relevant financial disclosures.