Health service costs in Europe: cost and reimbursement of primary hip replacement in nine countries

Abstract

SUMMARYThis paper assesses variations in the cost of primary hip replacement between and within nine member states of the European Union (EU). It also compares the cost of service with public-payer reimbursements. To do so, data on cost and reimbursement were surveyed at the micro-level in 42 hospitals in Denmark, England, France, Germany, Hungary, Italy, The Netherlands, Poland, and Spain.The total cost of treatment ranged from h1290 (Hungary) to h8739 (The Netherlands), with a mean cost of h5043 ðSTD AE h2071Þ: The main cost drivers were found to be implants (34% of total cost on average) and ward costs (20.9% of total cost on average). A one-way random effects analysis of variance model indicated that 74.0% of variation was between and only 26% of variation was within countries. In a two-level random-intercept regression model, purchasing-power parities explained 79.4% of the explainable between-country variation, while the percentage of uncemented implants used and the number of beds explained 12.1 and 1.6% of explainable withincountry variation, respectively.The large differences in cost and reimbursement between Poland, Hungary, and the other EU member states shows that primary total hip replacement is a highly relevant case for cross-border care.

Socioeconomic burden of total joint arthroplasty for symptomatic hip and knee osteoarthritis in the Italian population: A 5‐year analysis based on hospitalization records

“…We have estimated that total costs sustained for TJAs increased from 973 million to 1.4 billion euros, with the average cost per patient being 16,835 and 15,358 euros for hip and knee arthroplasties, respectively. Stargardt assessed the costs of primary hip arthroplasties performed in 42 hospitals of 9 European Union countries, finding that the total cost for THAs ranged from 1,290 euros (Hungary) to 8,739 euros (The Netherlands), with a mean cost of 5,043 euros (38). In that study, Italy was situated among the countries with the highest costs, as confirmed by our results.…”

Obesity Increases Length of Stay and Direct Medical Costs in Total Hip Arthroplasty

“…First, the time of our study is limited to the 3 months around the time of THA, and therefore, the long-term cost implications of obesity after THA are not addressed. Second, there is considerable geographic variation [40,42] in the practice of THA and our findings may not be generalizable to THAs in other institutions or countries. Nevertheless, our study has high internal validity because all exposure and outcome data are collected uniformly for all patients and comparisons are made across BMI categories.…”

Variability in healthcare treatment costs amongst nine EU countries – results from theHealthBASKET project

“…The hip replacement vignette, for example, was reimbursed at a (average) level of h8963 in Italy, compared with h1795 in Hungary (Stargardt, 2008). The AMI vignette showed some remarkable variations as well.…”