An economic analysis of aseptic revision hip arthroplasty: Calculation of partial hospital costs in relation to reimbursement

Assmann, Grit; Kasch, Richard; Hofer, André; Schulz, Arndt P.; Kayser, R.; Lahm, A.; Merk, H.; Fleßa, Steffen

doi:10.1007/s00402-014-1920-0

Cited by 18 publications

(15 citation statements)

References 17 publications

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“…As described in detail previously the analysis included variable and case fixed costs, following Kasch et al [24,29,31,41]. “Those costs could be directly related to an individual case and can be influenced directly.…”

Section: Methodsmentioning

confidence: 99%

“…To the best of our knowledge, all published cost studies of revision TKA, unlike those of aseptic and septic total hip revision, use a total cost approach [29–31], which provides no basis for economic decisions for the department performing this kind of surgery [15,26,32–36]. In contrast, the partial cost approach we present here and have already used for a similar study of hip replacement distinguishes variable from case-fixed costs [30].…”

Section: Introductionmentioning

confidence: 99%

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Comparative Analysis of Direct Hospital Care Costs between Aseptic and Two-Stage Septic Knee Revision

et al. 2017

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BackgroundThe most common intermediate and long-term complications of total knee arthroplasty (TKA) include aseptic and septic failure of prosthetic joints. These complications cause suffering, and their management is expensive. In the future the number of revision TKA will increase, which involves a greater financial burden. Little concrete data about direct costs for aseptic and two-stage septic knee revisions with an in depth-analysis of septic explantation and implantation is available.Questions/PurposesA retrospective consecutive analysis of the major partial costs involved in revision TKA for aseptic and septic failure was undertaken to compare 1) demographic and clinical characteristics, and 2) variable direct costs (from a hospital department’s perspective) between patients who underwent single-stage aseptic and two-stage septic revision of TKA in a hospital providing maximum care. We separately analyze the explantation and implantation procedures in septic revision cases and identify the major cost drivers of knee revision operations.MethodsA total of 106 consecutive patients (71 aseptic and 35 septic) was included. All direct costs of diagnosis, surgery, and treatment from the hospital department’s perspective were calculated as real purchase prices. Personnel involvement was calculated in units of minutes.ResultsAseptic versus septic revisions differed significantly in terms of length of hospital stay (15.2 vs. 39.9 days), number of reported secondary diagnoses (6.3 vs. 9.8) and incision-suture time (108.3 min vs. 193.2 min). The management of septic revision TKA was significantly more expensive than that of aseptic failure ($12,223.79 vs. $6,749.43) (p <.001).On the level of the separate hospitalizations the mean direct costs of explantation stage ($4,540.46) were lower than aseptic revision TKA ($6,749.43) which were again lower than those of the septic implantation stage ($7,683.33). All mean costs of stays were not comparable as they differ significantly (p <.001). Major cost drivers were the cost of the implant and general staff. The septic implantation part was on average $3,142.87 more expensive than septic explantations (p <.001).ConclusionsOur study for the first time provides a detailed analysis of the major direct case costs of aseptic and septic revision TKA from the hospital-department’s perspective which is the basis for long-term orientated decision making. In the future, our cost analysis has to be interpreted in relation to reimbursement estimates. This is important to check whether revision TKA lead to a financial loss for the operating department.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparative Analysis of Direct Hospital Care Costs between Aseptic and Two-Stage Septic Knee Revision

et al. 2017

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“…The average cost of aseptic revision operations conducted between 2009 and 2012 at a single hospital was €4,380. 72 This estimate included the cost of surgery (63% of the total) and normal ward (27%), including physiotherapy, diagnostic tests, medications, intensive care unit, physician and nursing staff.…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of timely versus delayed primary total hip replacement in Germany: A social health insurance perspective

Mújica-Mota¹,

Watson²,

Tarricone³

et al. 2017

Orthop Rev (Pavia)

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Without clinical guideline on the optimal timing for primary total hip replacement (THR), patients often receive the operation with delay. Delaying THR may negatively affect long-term health-related quality of life, but its economic effects are unclear. We evaluated the costs and health benefits of timely primary THR for functionally independent adult patients with end-stage osteoarthritis (OA) compared to non-surgical therapy followed by THR after progression to functional dependence (delayed THR), and non-surgical therapy alone (Medical Therapy), from a German Social Health Insurance (SHI) perspective. Data from hip arthroplasty registers and a systematic review of the published literature were used to populate a tunnel-state modified Markov lifetime model of OA treatment in Germany. A 5% annual discount rate was applied to costs (2013 prices) and health outcomes (Quality Adjusted Life Years, QALY). The expected future average cost of timely THR, delayed THR and medical therapy in women at age 55 were €27,474, €27,083 and €28,263, and QALYs were 20.7, 16.7, and 10.3, respectively. QALY differences were entirely due to health-related quality of life differences. The discounted cost per QALY gained by timely over delayed (median delay of 11 years) THR was €1270 and €1338 in women treated at age 55 and age 65, respectively, and slightly higher than this for men. Timely THR is cost-effective, generating large quality of life benefits for patients at low additional cost to the SHI. With declining healthcare budgets, research is needed to identify the characteristics of those able to benefit the most from timely THR.

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“…5. (Assmann et al 2014). The study focused on the direct costs of the intervention and compared these with the respective DRG calculations.…”

Section: Direct Costsmentioning

confidence: 99%

“…DRG calculations are maintained by the German Institute for Hospital Reimbursement »Institut für das Entgeltsystem im Krankenhaus (InEK)« using cost data from several hundred German hospitals (7 Chapter 5.2). An analysis published by Assmann et al (2014) grouped the cost components into two cost items: the hospital ward costs and the actual surgery costs.…”

Section: Direct Costsmentioning

confidence: 99%

Health Economic Aspects

Weißer¹,

Rosery²,

Schönfelder

2018

White Paper on Joint Replacement

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An economic analysis of aseptic revision hip arthroplasty: Calculation of partial hospital costs in relation to reimbursement

Cited by 18 publications

References 17 publications

Comparative Analysis of Direct Hospital Care Costs between Aseptic and Two-Stage Septic Knee Revision

Comparative Analysis of Direct Hospital Care Costs between Aseptic and Two-Stage Septic Knee Revision

Cost-effectiveness of timely versus delayed primary total hip replacement in Germany: A social health insurance perspective

Health Economic Aspects

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