Clinical Orthopaedics and Related Research®

, Volume 470, Issue 4, pp 1065–1072 | Cite as

Measuring the Value of Total Hip and Knee Arthroplasty: Considering Costs Over the Continuum of Care

  • Deborah A. Marshall
  • Tracy Wasylak
  • Hoa Khong
  • Robyn D. Parker
  • Peter D. Faris
  • Cy Frank
Symposium: Value Based Healthcare

Abstract

Background

Controlling escalating costs of hip (THA) and knee arthroplasty (TKA) without compromising quality of care has created the need for innovative system reorganization to inform sustainable solutions.

Questions/purposes

The purpose of this study was to inform estimates of the value of THA and TKA by determining: (1) the data sources data required to obtain costs across the care continuum; (2) the data required for different analytical perspectives; and (3) the relative costs across the continuum of care.

Methods

Within the context of a pragmatic randomized controlled trial comparing alternative care pathways, we captured healthcare resource use: (1) 12 months before surgery; (2) inpatient; (3) acute recovery; and (4) long-term recovery 3 and 12 months postsurgery. We established a standardized costing model to reflect both the healthcare payer and patient perspectives.

Results

Multiple data sources from regional health authorities, administrative databases, and patient questionnaire were required to estimate costs across the care continuum. Inpatient and acute care costs were approximately 60% of the total with the remaining 40% incurred 12 months presurgery and 12 months postsurgery. Regional health authorities bear close to 60%, and patient costs are approximately 30% of the mean total costs, most of which were incurred after the acute inpatient stay.

Conclusions

To fully understand the value of an orthopaedic intervention such as THA and TKA, a broader perspective than one limited to the payer should be considered using a standardized measurement framework over a relevant time horizon and from multiple viewpoints to reflect the substantial patient burden and support sustainable improvement over the care continuum.

Level of Evidence

Level III, economic and decision analyses study. See Guidelines for Authors for a complete description of levels of evidence.

References

  1. 1.
    Alberta Health and Wellness. Alberta Hip and Knee Replacement Project Evaluation Report. Edmonton, Alberta: Alberta Health and Wellness; 2006.Google Scholar
  2. 2.
    Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.PubMedGoogle Scholar
  3. 3.
    Bozic KJ, Saleh KJ, Rosenberg AG, Rubash HE. Economic evaluation in total hip arthroplasty: analysis and review of the literature. J Arthroplasty. 2004;19:180–189.PubMedCrossRefGoogle Scholar
  4. 4.
    Canadian Agency for Drugs and Technologies in Health. Guidelines for the Economic Evaluation of Health Technologies: Canada. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2006.Google Scholar
  5. 5.
    Canadian Coordinating Office for Health Technology Assessment. A Guidance Document for the Costing Process. Ottawa: Canadian Coordinating Office for Health Technology Assessment; 1996.Google Scholar
  6. 6.
    Canadian Institutes of Health Research. CIHR Travel Expenses Reimbursement Guidelines; 2007. Available at: www.cihr-irsc.gc.ca/e/35135.html. Accessed December 13, 2010.
  7. 7.
    Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ, Stoddart GL. Methods for the Economic Evaluation of Health Care Programmes. 3rd ed. Oxford, UK: Oxford University Press; 2005.Google Scholar
  8. 8.
    Gold MR, Siegel JE, Russell LB, Weinstein MC. Cost-effectiveness in Health and Medicine. New York: Oxford University Press; 1996.Google Scholar
  9. 9.
    Gooch KL, Smith D, Wasylak T, Faris PD, Marshall DA, Kong H, Hibbert JE, Parker RD, Zernicke RF, Beaupre L, Pearce T, Johnston DW, Frank CB. The Alberta Hip and Knee Replacement Project: a model for health technology assessment based on comparative effectiveness of clinical pathways. Int J Technol Assess Health Care. 2009;25:113–123.PubMedCrossRefGoogle Scholar
  10. 10.
    Government of Alberta. Alberta WAGEinfo. Available at: http://alis.alberta.ca/wageinfo. Accessed December 13, 2010.
  11. 11.
    Hawker GA, Badley EM, Croxford R, Coyte PC, Glazier RH, Guan J, Harvey BJ, Williams JI, Wright JG. A population-based nested case-control study of the costs of hip and knee replacement surgery. Med Care. 2009;47:732–741.PubMedCrossRefGoogle Scholar
  12. 12.
    Health Quality Council of Alberta. Alberta Quality Maxrix for Health. Alberta: Health Quality Council of Alberta; 2004.Google Scholar
  13. 13.
    Heiner DE, Mauerhan DR, Masonis JL, Heath J. Patient out-of-pocket expenses in major orthopedic procedures: total hip arthroplasty as a case study. J Arthroplasty. 2008;23:509–514.PubMedCrossRefGoogle Scholar
  14. 14.
    Willan AR, Briggs AH. Statistical Analysis of Cost-effectiveness Data. Oxford, UK: John Wiley & Sons Ltd; 2006.CrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Deborah A. Marshall
    • 1
    • 2
    • 3
  • Tracy Wasylak
    • 4
  • Hoa Khong
    • 2
  • Robyn D. Parker
    • 1
    • 2
  • Peter D. Faris
    • 1
    • 2
    • 4
  • Cy Frank
    • 1
    • 2
    • 3
  1. 1.University of CalgaryCalgaryCanada
  2. 2.Alberta Bone & Joint Health InstituteCalgaryCanada
  3. 3.McCaig Institute for Bone & Joint HealthCalgaryCanada
  4. 4.Alberta Health ServicesCalgaryCanada

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