An economic analysis of aseptic revision hip arthroplasty: Calculation of partial hospital costs in relation to reimbursement
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Abstract
Introduction
Aseptic loosening is one of the most common intermediate and long-term complications after total hip replacement (THR). These complications cause suffering and require expensive revision surgery. Little concrete data on direct costs are available from the hospital’s, moreover operating department’s perspective. We here provide a detailed analysis of the costs of THR revision and relate them to reimbursement underlying the German diagnosis-related groups (DRG) system.
Materials and methods
Major cost parameters were identified using for orientation the cost matrix of the German Institute for Hospital Reimbursement (InEK GmbH). We then retrospectively analysed the major direct costs of aseptic revision THR in terms of contribution margins I and II. The analysis included a total of 114 patients who underwent aseptic revision from 1 January 2009 to 31 March 2012. Data were retrieved from the hospital information system and patient records. All costs of surgery, diagnostic tests, and other treatments were calculated as purchase prices in EUR. The comparative analysis of direct costs and reimbursements was done for DRG I46A and I46B from the hospital’s, especially treating department’s rather than the society or healthcare insurance’s perspective.
Results
The average direct cost incurred by the hospital for a THR revision was €4,380.0. The largest share was accounted for surgical costs (62.7 % of total). Implant and staff costs were identified as the most important factors that can be influenced. The proportion of the daily contribution margin that was left to cover the hospital’s indirect cost decreased with the relative cost weight of the DRG to which a patient was assigned.
Conclusion
Our study for the first time provides a detailed analysis of the major direct case costs of THR revision for aseptic loosening from the provider’s perspective. Our findings suggest that these revision operations could be performed cost-beneficially by the operating unit. From an economic perspective, cases with higher cost weights are more favorable for a hospital. These results need to be confirmed in multicenter studies.
Keywords
Arthroplasty Cost DRG-system Hip Hospital perspective Reimbursement Revision surgeryNotes
Conflict of interest
None.
References
- 1.Birrell F, Johnell O, Silman A (1999) Projecting the need for hip replacement over the next three decades: influence of changing demography and threshold for surgery. Ann Rheum Dis 58(9):569–572PubMedCrossRefGoogle Scholar
- 2.Fordham R, Skinner J, Wang X, Nolan J, Exeter Primary Outcome Study G (2012) The economic benefit of hip replacement: a 5-year follow-up of costs and outcomes in the Exeter Primary Outcomes Study. BMJ open 2(3):e000752. doi: 10.1136/bmjopen-2011-000752 PubMedCentralPubMedCrossRefGoogle Scholar
- 3.Krummenauer F, Wolf C, Gunther KP, Kirschner S (2009) Clinical benefit and cost effectiveness of total knee arthroplasty in the older patient. Eur J Med Res 14(2):76–84PubMedCentralPubMedCrossRefGoogle Scholar
- 4.Losina E, Walensky RP, Kessler CL, Emrani PS, Reichmann WM, Wright EA, Holt HL, Solomon DH, Yelin E, Paltiel AD, Katz JN (2009) Cost-effectiveness of total knee arthroplasty in the United States: patient risk and hospital volume. Archives Intern Med 169(12):1113–1121. doi: 10.1001/archinternmed.2009.136 Discussion 1121–1112CrossRefGoogle Scholar
- 5.Quintana JM, Escobar A, Arostegui I, Bilbao A, Azkarate J, Goenaga JI, Arenaza JC (2006) Health-related quality of life and appropriateness of knee or hip joint replacement. Arch Intern Med 166(2):220–226. doi: 10.1001/archinte.166.2.220 PubMedCrossRefGoogle Scholar
- 6.Herberts P, Malchau H (2000) Long-term registration has improved the quality of hip replacement: a review of the Swedish THR Register comparing 160,000 cases. Acta Orthop Scand 71(2):111–121. doi: 10.1080/000164700317413067 PubMedCrossRefGoogle Scholar
- 7.Marks R (2009) Body mass characteristics of hip osteoarthritis patients experiencing aseptic loosening, periprosthetic fractures, dislocation, and infections after total hip replacement. CEOR 1:7–16CrossRefGoogle Scholar
- 8.Gudena R, Kuna S, Pradhan N (2011) Aseptic loosening of total hip replacement presenting as an anterior thigh mass. Musculoskelet Surg. doi: 10.1007/s12306-011-0167-y PubMedGoogle Scholar
- 9.Roeder N, Rochell B, Bunzemeier H (2001) Klinische Kostenverteilungsmodelle–Die Kür der DRG-Kostenkalkulation. F&W, führen und wirtschaften im Krankenhaus 17 Jg:S 442–447Google Scholar
- 10.Flessa S (2010) Grundzüge der Krankenhausbetriebslehre, 2nd edn. Oldenbourg Wissenschaftsverlag, MünchenGoogle Scholar
- 11.Busse R, Schreyögg J, Tiemann O (2010) Management im Gesundheitswesen, 2nd edn. Springer Verlag, Berlin HeidelbergCrossRefGoogle Scholar
- 12.Lauterbach KW, Stock S, Brunner H (2009) Gesundheitsökonomie, vol 2. Hans Huber, BernGoogle Scholar
- 13.Schmalen H, Pechtl H (2009) Grundlagen und Probleme der Betriebswirtschaft, vol 14. Schäffer Poeschel, StuttgartGoogle Scholar
- 14.Straub T (2011) Einführung in die Allgemeine Betriebswirtschaftslehre, vol 1. Pearson Studium, MünchenGoogle Scholar
- 15.Wöhe G, Döring, U (2010) Einführung in die Allgemeine Betriebswirtschaftslehre, vol 24. VahlenGoogle Scholar
- 16.InEK GmbH (2011) KalkulationshandbuchGoogle Scholar
- 17.Hollnecker JKC, Wedemeyer S, Gemmel J (2008) Pfadcontrolling-softwaregestütztes Controlling klinischer Behandlungspfade. Das Krankenhaus 12:1353–1356Google Scholar
- 18.Kasch R, Merk S, Drescher W, Schulz AP, Kayser R, Skripitz R, Frohlich S, Lahm A, Merk H, Flessa S (2012) Marginal contribution of UKS- versus TKA in varus arthritis of the knee. Arch Orthop Trauma Surg 132(8):1165–1172. doi: 10.1007/s00402-012-1535-2 PubMedCrossRefGoogle Scholar
- 19.InEK GmbH (2011) G-DRG-Fallpauschalen-KatalogGoogle Scholar
- 20.Flessa S (2008) Grundzüge der Krankenhaussteuerung, vol 1. Oldenbourg Wissenschaftsverlag, MünchenCrossRefGoogle Scholar
- 21.Romano CL, Romano D, Logoluso N, Meani E (2010) Septic versus aseptic hip revision: how different? J Orthop Traumatol 11(3):167–174. doi: 10.1007/s10195-010-0106-y PubMedCrossRefGoogle Scholar
- 22.Haenle M, Skripitz C, Mittelmeier W, Skripitz R (2012) Economic impact of infected total hip arthroplasty in the German diagnosis-related groups system. Der Orthopade 41(6):467–476. doi: 10.1007/s00132-012-1939-2 PubMedCrossRefGoogle Scholar
- 23.Vanhegan IS, Malik AK, Jayakumar P, Ul Islam S, Haddad FS (2012) A financial analysis of revision hip arthroplasty: the economic burden in relation to the national tariff. J Bone Joint Sur Br 94(5):619–623. doi: 10.1302/0301-620X.94B5.27073 CrossRefGoogle Scholar
- 24.Bozic KJ, Stacey B, Berger A, Sadosky A, Oster G (2012) Resource utilization and costs before and after total joint arthroplasty. BMC Health Serv Res 12:73. doi: 10.1186/1472-6963-12-73 PubMedCentralPubMedCrossRefGoogle Scholar
- 25.Crowe JF, Sculco TP, Kahn B (2003) Revision total hip arthroplasty: hospital cost and reimbursement analysis. Clin Orthop Relat Res 413:175–182. doi: 10.1097/01.blo.0000072469.32680.b6 PubMedCrossRefGoogle Scholar
- 26.InEK GmbH (2010) G-DRG Report Browser 2009/2011. http://www.g-drg.de/cms/G-DRG-System_2011/Abschlussbericht_zur_Weiterentwicklung_des_G-DRG-Systems_und_Report_Browser/Report-Browser_2009_2011
- 27.Barrack RL (1995) Economics of revision total hip arthroplasty. Clin Orthop Relat Res 319:209–214PubMedGoogle Scholar
- 28.Bozic KJ, Katz P, Cisternas M, Ono L, Ries MD, Showstack J (2005) Hospital resource utilization for primary and revision total hip arthroplasty. Journal Bone Joint Sur Am 87(3):570–576. doi: 10.2106/JBJS.D.02121 Google Scholar