1. Measuring the value of total hip and knee arthroplasty: considering costs over the continuum of care.
- Author
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Marshall DA, Wasylak T, Khong H, Parker RD, Faris PD, Frank C, Marshall, Deborah A, Wasylak, Tracy, Khong, Hoa, Parker, Robyn D, Faris, Peter D, and Frank, Cy
- 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. [ABSTRACT FROM AUTHOR]- Published
- 2012
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