Variation in the Cost of Care for Different Types of Joint Arthroplasty
Variation in the Cost of Care for Different Types of Joint Arthroplasty
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DOI：
10.2106/jbjs.19.00164
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发表时间：
2020-03-04
影响因子：
5.3
通讯作者：
Jawa, Andrew
中科院分区：
文献类型：
--
作者：
Carducci, Michael P.;Gasbarro, Gregory;Jawa, Andrew
背景：下肢关节成形术构成了医疗保险诊断组中最大的医疗保健支出负担。上肢关节成形术的需求也在持续上升。有必要更好地了解成本，因为医疗保健转向一个付费会计方法。我们的目的是（1）确定不同类型关节置换术的总成本是否存在差异，如果存在差异，（2）确定哪些成本参数导致这种差异。研究方法：2015年至2018年，通过在一家骨科专科医院实施时间驱动的基于活动的成本计算（TDABC），计算了22，215例全关节置换术的住院治疗费用。分析了全膝关节、全髋关节、解剖型全肩关节、反向全肩关节、全肘关节和全踝关节置换术的植入物价格、供应成本、人员成本和住院时间。将单个成本参数与总成本和体积进行比较。结果：较高的植入物成本似乎与较高的总成本相关，占住院治疗周期总成本的53.8%。全膝关节置换术是最便宜和最大的手术量，而全肘关节置换术的手术量最小，费用最高（是全膝关节置换术的1.65倍）。住院时间与增加的人事成本相关，但对总成本没有显着影响。结论：在我们骨科专科医院，不同关节置换术领域的总住院费用差异高达1.65倍。数量最多的手术全膝关节和髋关节置换术是最便宜的，主要是由于植入物购买价格较低。
Background: Lower-extremity arthroplasty constitutes the largest burden on health-care spending of any Medicare diagnosis group. Demand for upper extremity arthroplasty also continues to rise. It is necessary to better understand costs as health care shifts toward a bundled-payment accounting approach. We aimed (1) to identify whether variation exists in total cost for different types of joint arthroplasty, and, if so, (2) to determine which cost parameters drive this variation. Methods: The cost of the episode of inpatient care for 22,215 total joint arthroplasties was calculated by implementing time-driven activity-based costing (TDABC) at a single orthopaedic specialty hospital from 2015 to 2018. Implant price, supply costs, personnel costs, and length of stay for total knee, total hip, anatomic total shoulder, reverse total shoulder, total elbow, and total ankle arthroplasty were analyzed. Individual cost parameters were compared with total cost and volume. Results: Higher implant cost appeared to correlate with higher total costs and represented 53.8% of the total cost for an inpatient care cycle. Total knee arthroplasty was the least-expensive and highest-volume procedure, whereas total elbow arthroplasty had the lowest volume and highest cost (1.65 times more than that of total knee arthroplasty). Length of stay was correlated with increased personnel cost but did not have a significant effect on total cost. Conclusions: Total inpatient cost at our orthopaedic specialty hospital varied by up to a factor of 1.65 between different fields of arthroplasty. The highest-volume procedures-total knee and hip arthroplasty-were the least expensive, driven predominantly by lower implant purchase prices.