In the JournalsPerspective

Indirect cost savings of hip arthroscopy may reduce economic burden of FAI syndrome

Hip arthroscopy for treatment of femoroacetabular impingement may provide economic benefits through indirect cost savings that exceed the direct costs of treatment compared with nonoperative management, according to results published in The American Journal of Sports Medicine.

To identify cost-effectiveness of hip arthroscopy vs. nonoperative treatment of femoroacetabular impingement (FAI) syndrome, Richard C. Mather III, MD, MBA, and colleagues used CPT medical codes associated with FAI treatment to calculate direct costs. To measure indirect costs, they used patient-reported data of 102 patients who underwent arthroscopy and reimbursement records of 32,143 individuals aged between 16 years and 79 years who had information in a private insurance claims data set contained within the PearlDiver Patient Records Database. Researchers inferred indirect economic benefits of hip arthroscopy through regression analysis to estimate the statistical relationship between functional status and productivity before employing a simulation-based approach to estimate the change in productivity associated with the change in functional status between baseline and follow-up. They used one-, two- and three-way sensitivity analyses on all variables in the model to analyze cost-effectiveness, while they evaluated the impact of uncertainty in model assumptions through Monte Carlo analysis.

In the analysis of indirect costs, results showed a statistically significant increase of mean aggregate productivity of $8,968 after surgery. Compared with nonoperative treatment, researchers found hip arthroscopy had a mean cumulative total 10-year societal savings of $67,418 per patient through cost-effectiveness analysis, and a gain of 2.03 quality-adjusted life years. Hip arthroscopy had a mean cost estimated at approximately $23,120, according to the data, while nonoperative treatment had a mean cost estimated at approximately $91,602. Investigators noted the preferred cost-effective strategy in 99% of trials was hip arthroscopy.

“FAI syndrome creates substantial disability resulting in lower likelihood of employment and lower earnings,” Mather told Healio.com/Orthopedics. “Hip arthroscopy successfully addresses that disability generating economic benefit well in excess of the direct costs of treatment and more than treatment of ACL and rotator cuff tears and total knee arthroplasty. These findings are relevant when considering access to care for FAI syndrome and research priorities and funding as well as individual patient treatment decision making.” – by Casey Tingle

Disclosures: Mather reports he is a paid consultant for KNG Health Consulting and Stryker, and receives research support from Zimmer. Please see the full study for a list of all other authors’ relevant financial disclosures.

Hip arthroscopy for treatment of femoroacetabular impingement may provide economic benefits through indirect cost savings that exceed the direct costs of treatment compared with nonoperative management, according to results published in The American Journal of Sports Medicine.

To identify cost-effectiveness of hip arthroscopy vs. nonoperative treatment of femoroacetabular impingement (FAI) syndrome, Richard C. Mather III, MD, MBA, and colleagues used CPT medical codes associated with FAI treatment to calculate direct costs. To measure indirect costs, they used patient-reported data of 102 patients who underwent arthroscopy and reimbursement records of 32,143 individuals aged between 16 years and 79 years who had information in a private insurance claims data set contained within the PearlDiver Patient Records Database. Researchers inferred indirect economic benefits of hip arthroscopy through regression analysis to estimate the statistical relationship between functional status and productivity before employing a simulation-based approach to estimate the change in productivity associated with the change in functional status between baseline and follow-up. They used one-, two- and three-way sensitivity analyses on all variables in the model to analyze cost-effectiveness, while they evaluated the impact of uncertainty in model assumptions through Monte Carlo analysis.

In the analysis of indirect costs, results showed a statistically significant increase of mean aggregate productivity of $8,968 after surgery. Compared with nonoperative treatment, researchers found hip arthroscopy had a mean cumulative total 10-year societal savings of $67,418 per patient through cost-effectiveness analysis, and a gain of 2.03 quality-adjusted life years. Hip arthroscopy had a mean cost estimated at approximately $23,120, according to the data, while nonoperative treatment had a mean cost estimated at approximately $91,602. Investigators noted the preferred cost-effective strategy in 99% of trials was hip arthroscopy.

“FAI syndrome creates substantial disability resulting in lower likelihood of employment and lower earnings,” Mather told Healio.com/Orthopedics. “Hip arthroscopy successfully addresses that disability generating economic benefit well in excess of the direct costs of treatment and more than treatment of ACL and rotator cuff tears and total knee arthroplasty. These findings are relevant when considering access to care for FAI syndrome and research priorities and funding as well as individual patient treatment decision making.” – by Casey Tingle

Disclosures: Mather reports he is a paid consultant for KNG Health Consulting and Stryker, and receives research support from Zimmer. Please see the full study for a list of all other authors’ relevant financial disclosures.

    Perspective
    Benjamin G. Domb

    Benjamin G. Domb

    FAI has been through a long and difficult road since its inception. Its very concept and the advantages of surgical treatment have been questioned.

    Minimally invasive ways to treat and fix articular pathologies are “a must” in today’s world of orthopedics. Knee and shoulder arthroscopy, which are currently taken for granted, also have had complicated beginnings. Only through rigorous demonstration of results and long-term outcomes have the most critical retractors been convinced of their effectiveness.  

    With appropriate indications and meticulous technique, good outcomes can be achieved in the treatment of FAI with hip arthroscopy. However, cost is a concern.

    The study presented by Richard C. Mather III and colleagues, which includes an elaborate cost-effectiveness model, demonstrated first, that FAI is an economic burden to society; and second, that hip arthroscopy appears to alleviate this burden substantially if performed by the hands of high-volume surgeons. These savings can, in fact, be superior to nonsurgical options.

    Existing literature has demonstrated that, while technically challenging, well-performed FAI surgery can help patients who are suffering in pain. This study goes one step further, supporting hip arthroscopy as a cost-effective tool for FAI treatment.

    • Benjamin G. Domb, MD

    • Medical director
      American Hip Institute
      Westmont, Illinois

      Ajay C. Lall, MD

      Orthopedic surgeon
      American Hip Institute Westmont, Illinois
      David Maldonado, MD
      American Hip Institute
      Westmont, Illinois

    Disclosures: Domb reports he is a board member for the American Orthopedic Foundation, the American Hip Foundation, the Arthroscopy Association of North America Learning Center Committee, the Hinsdale Hospital Foundation and Arthroscopy Journal; receives research support from Arthrex, Medacta and Stryker; is a consultant for Adventist Hinsdale Hospital, Amplitude, Arthrex, Medacta and Stryker; receives royalties from Arthrex, DJO Global and Orthomerica; and has ownership interest in Hinsdale Orthopedic Associates, Hinsdale Orthopedic Imaging, American Hip Institute, SCD#3, North Shore Surgical Suites and Munster Specialty Surgery Center. Maldonado and Lall report no relevant financial disclosures.