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.
RCT Entities:
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.
Authors: Gillian A Hawker; Elizabeth M Badley; Ruth Croxford; Peter C Coyte; Richard H Glazier; Jun Guan; Bart J Harvey; J I Williams; James G Wright Journal: Med Care Date: 2009-07 Impact factor: 2.983
Authors: Katherine L Gooch; Douglas Smith; Tracy Wasylak; Peter D Faris; Deborah A Marshall; Hoa Khong; Julie E Hibbert; Robyn D Parker; Ronald F Zernicke; Lauren Beaupre; Tim Pearce; D W C Johnston; Cyril B Frank Journal: Int J Technol Assess Health Care Date: 2009-04 Impact factor: 2.188
Authors: Holly Reid; Somayyeh Mohammadi; Wendy Watson; Julie M Robillard; Morag Crocker; Marie D Westby; William C Miller Journal: Rehabil Process Outcome Date: 2021-04-21
Authors: Daniel L Riddle; Francis J Keefe; Dennis Ang; Khaled J; Levent Dumenci; Mark P Jensen; Matthew J Bair; Shelby D Reed; Kurt Kroenke Journal: BMC Musculoskelet Disord Date: 2012-08-20 Impact factor: 2.362