Richard C Mather1, Shane J Nho2, Andrew Federer1, Berna Demiralp3, Jennifer Nguyen3, Asha Saavoss3, Michael J Salata4, Marc J Philippon5, Asheesh Bedi6, Christopher M Larson7, J W Thomas Byrd8, Lane Koenig3. 1. Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA. 2. Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA. 3. KNG Health Consulting, LLC, Rockville, Maryland, USA. 4. Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA. 5. Steadman Philippon Research Institute, Vail, Colorado, USA. 6. Department of Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA. 7. Minnesota Orthopedic Sports Medicine Institute, Twin Cities Orthopedics, Edina, Minnesota, USA. 8. Nashville Sports Medicine Foundation, Nashville, Tennessee, USA.
Abstract
BACKGROUND: The diagnosis and treatment of femoroacetabular impingement (FAI) have increased steadily within the past decade, and research indicates clinically significant improvements after treatment of FAI with hip arthroscopy. PURPOSE: This study examined the societal and economic impact of hip arthroscopy by high-volume surgeons for patients with FAI syndrome aged <50 years with noncontroversial diagnosis and indications for surgery. STUDY DESIGN: Economic and decision analysis; Level of evidence, 2. METHODS: The cost-effectiveness of hip arthroscopy versus nonoperative treatment was evaluated by calculating direct and indirect treatment costs. Direct cost was calculated with Current Procedural Terminology medical codes associated with FAI treatment. Indirect cost was measured with the patient-reported data of 102 patients who underwent arthroscopy and from the reimbursement records of 32,143 individuals between the ages of 16 and 79 years who had information in a private insurance claims data set contained within the PearlDiver Patient Records Database. The indirect economic benefits of hip arthroscopy were inferred through regression analysis to estimate the statistical relationship between functional status and productivity. A simulation-based approach was then used to estimate the change in productivity associated with the change in functional status observed in the treatment cohort between baseline and follow-up. To analyze cost-effectiveness, 1-, 2-, and 3-way sensitivity analyses were performed on all variables in the model, and Monte Carlo analysis evaluated the impact of uncertainty in the model assumptions. RESULTS: Analysis of indirect costs identified a statistically significant increase of mean aggregate productivity of $8968 after surgery. Cost-effectiveness analysis showed a mean cumulative total 10-year societal savings of $67,418 per patient from hip arthroscopy versus nonoperative treatment. Hip arthroscopy also conferred a gain of 2.03 quality-adjusted life years over this period. The mean cost for hip arthroscopy was estimated at $23,120 ± $10,279, and the mean cost of nonoperative treatment was estimated at $91,602 ± $14,675. In 99% of trials, hip arthroscopy was recognized as the preferred cost-effective strategy. CONCLUSION: FAI syndrome produces a substantial economic burden on society that may be reduced through the indirect cost savings and economic benefits from hip arthroscopy.
BACKGROUND: The diagnosis and treatment of femoroacetabular impingement (FAI) have increased steadily within the past decade, and research indicates clinically significant improvements after treatment of FAI with hip arthroscopy. PURPOSE: This study examined the societal and economic impact of hip arthroscopy by high-volume surgeons for patients with FAI syndrome aged <50 years with noncontroversial diagnosis and indications for surgery. STUDY DESIGN: Economic and decision analysis; Level of evidence, 2. METHODS: The cost-effectiveness of hip arthroscopy versus nonoperative treatment was evaluated by calculating direct and indirect treatment costs. Direct cost was calculated with Current Procedural Terminology medical codes associated with FAI treatment. Indirect cost was measured with the patient-reported data of 102 patients who underwent arthroscopy and from the reimbursement records of 32,143 individuals between the ages of 16 and 79 years who had information in a private insurance claims data set contained within the PearlDiver Patient Records Database. The indirect economic benefits of hip arthroscopy were inferred through regression analysis to estimate the statistical relationship between functional status and productivity. A simulation-based approach was then used to estimate the change in productivity associated with the change in functional status observed in the treatment cohort between baseline and follow-up. To analyze cost-effectiveness, 1-, 2-, and 3-way sensitivity analyses were performed on all variables in the model, and Monte Carlo analysis evaluated the impact of uncertainty in the model assumptions. RESULTS: Analysis of indirect costs identified a statistically significant increase of mean aggregate productivity of $8968 after surgery. Cost-effectiveness analysis showed a mean cumulative total 10-year societal savings of $67,418 per patient from hip arthroscopy versus nonoperative treatment. Hip arthroscopy also conferred a gain of 2.03 quality-adjusted life years over this period. The mean cost for hip arthroscopy was estimated at $23,120 ± $10,279, and the mean cost of nonoperative treatment was estimated at $91,602 ± $14,675. In 99% of trials, hip arthroscopy was recognized as the preferred cost-effective strategy. CONCLUSION:FAI syndrome produces a substantial economic burden on society that may be reduced through the indirect cost savings and economic benefits from hip arthroscopy.
Entities:
Keywords:
decision analysis; economic analysis; femoroacetabular impingement; hip arthroscopy
Authors: Betina B Hinckel; Charles A Baumann; Leandro Ejnisman; Leonardo M Cavinatto; Alexander Martusiewicz; Miho J Tanaka; Marc Tompkins; Seth L Sherman; Jorge A Chahla; Rachel Frank; Guilherme L Yamamoto; James Bicos; Liza Arendt; Donald Fithian; Jack Farr Journal: J Am Acad Orthop Surg Glob Res Rev Date: 2020-10-01
Authors: Marsalis Brown; Thiran Udawatta; Lance Flesch; Gregory J Strnad; Isaac Briskin; Morgan Jones; Scott Kaar; James T Rosneck; Lutul D Farrow Journal: Orthop J Sports Med Date: 2022-02-07
Authors: Geoffrey P Wilkin; Stéphane Poitras; John Clohisy; Etienne Belzile; Ira Zaltz; George Grammatopoulos; Gerd Melkus; Kawan Rakhra; Tim Ramsay; Kednapa Thavorn; Paul E Beaulé Journal: Trials Date: 2020-08-18 Impact factor: 2.279
Authors: Flávio Luís Garcia; Brady T Williams; Evan M Polce; Daniel B Heller; Zachary S Aman; Benedict U Nwachukwu; Shane J Nho; Jorge Chahla Journal: Orthop J Sports Med Date: 2020-10-29