Best poster evaluates economic burden of TJR

By: Jennie McKee

By Jennie McKee

According to the authors of the overall best poster at the 2010 Annual Meeting, orthopaedic-related costs for patients who undergo total hip or total knee replacement account for less than half of all costs incurred during the 3 years prior to and the 3 years after the procedure.

The objective of the study was to report the actual economic burden placed on Medicare and commercial insurance companies by patients who undergo total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures.

“With increasing budgetary pressure and numbers of elderly patients who may be seeking these surgeries to relieve their hip and knee problems,” noted the researchers, “reliable and objective quantification of the economic and epidemiologic characteristics of these surgeries is critically needed.”

Obtaining data
The retrospective, longitudinal database audit analyzed data from the Thomson Reuters MarketScanĀ® Commercial Claims and Encounters Database and Medicare Supplemental and Coordination of Benefits Database.

International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes were used to identify claims of patients who underwent either THA or TKA. Of the 93,717 records identified, 29,225 patients underwent primary THA, and 64,492 patients underwent primary TKA between January 1, 2003 and December 21, 2006. Primary THA patients had a mean age of 65.8 years; 54.9 percent were female. Primary TKA patients had a mean age of 66.6 years; 62.6 percent were female.

“Only adult patients who had at least 12 months of continuous health plan enrollment in the pre- and post-arthroplasty period, and did not have any diagnosis for bone cancers, were included in the analysis,” noted the researchers.

Data end points were segmented into orthopaedic versus non–orthopaedic-related care for both inpatient and outpatient claims. Investigators analyzed the following cost variables:

  • Hospital access
  • In-patient hospital stay
  • Orthopaedic procedures
  • Medications
  • Outpatient drug utilization
  • Specialty provider visits and contacts with medical specialty in the 3-year presurgery or 3-year postsurgery period

“Costs were extrapolated as reimbursement payment requests made by institution and provider to third-party Medicare and commercial payers,” noted the researchers, adding that costs were adjusted to December 2007 dollars by multiplying each year’s cost by the Medical Care Consumer Price Index.

Primary THA patients had a mean of $80,484 in total economic costs during the study period, of which $35,168 (43.7 percent) was related to orthopaedic care. Primary TKA patients had a mean of $87,172 in total economic costs during the same time frame, of which $37,072 (42.5 percent) was orthopaedic-related.

This model indicates that the direct orthopaedic cost for THAs may have approached $4.43 billion in 2003 and increased to $5.56 billion in 2006, representing a 12 percent change in volume and a 10 percent change in annual costs. In addition, costs approached $8.47 billion for TKAs in 2003, and increased to $12.3 billion in 2006, indicating a 23 percent increase in volume and a 10 percent increase in annual costs.

Although postsurgery utilization was as expected for orthopaedic procedures, the percentage of patients who received physical and occupational therapy services or visiting physical medicine/rehabilitation specialists after surgery was lower than anticipated.

The results of this study provide information for an “economic cost of illness model” for total joint replacement (TJR), said the researchers.

“This model,” they noted, “provides a useful reference of both Medicare and commercial patients as policymakers evaluate resource allocation in ongoing healthcare reform debates.”

P271: The Total “Economic Cost” of Primary Total Joint Replacement Surgery in the United States was authored by Ryan Michael Graver, MPH; Lisa Da Deppo, PharmD, MPH, MSc; Erik M. Harris, MHA; Shamiram R. Feinglass, MD, MPH. Mr. Graver and Dr. Feinglass report ties to Zimmer; disclosure information on the other authors was not available.