Reducing PJI Can Have a Big Impact on Costs Associated with THA
With the advent of bundled payment models, the importance of finding ways to maximize outcomes while decreasing overall cost is more important than ever before.
Ryan Roach, MD, and Ajit Deshmukh, MD
Shearer DW, Youm J, Bozic K. Short-term complications have more effect on cost-effectiveness of THA than implant longevity. Clin Orthop Relat Res (2015) 473:1702-1708
Using the Markov model, researchers investigated the effect of reducing short- and long-term complications of total hip arthroplasty on net monetary benefit, which was defined as a combination of reduction in cost and improvement in quality adjusted life years (QALYs).
The Markov model is a method of predicting long-term outcomes of various interventions based on specific probability variables without actually collecting data over the lifespan of prosthesis. The specific interventions in this study included:
- Periprosthetic infection requiring 2-stage revision
- Unplanned readmission within a 90-day postoperative period
- Revision THA due to aseptic loosening
The incidence of each intervention was decreased by 10% and applied throughout the model. Probability variables were obtained from the Australian Orthopaedic Association National Joint Reconstruction Registry, which is considered to be the most valid data source in the literature.
The primary outcome of net monetary benefit was found to be:
- $278 (95% CI, $239–$295) per index procedure for a 10% reduction in periprosthetic joint infections
- $174 (95% CI, $150–$185) per index procedure for a 10% reduction in aseptic loosening
- $113 (95% CI, $94–$129) per index procedure for a 10% reduction in early readmission
Compared with the quoted control in the study, reductions in cost associated with a 10% reduction in periprosthetic joint infections, early readmissions, and aseptic loosening were $98, $93, and $75 per index procedure, respectively.
The same 10% reduction in periprosthetic joint infections, early readmissions, and aseptic loosening when compared to the control increased the QALYs by 0.0036, 0.002, and 0.0004 respectively.
Results were most sensitive to age, baseline rate of readmission, periprosthetic joint infection, aseptic loosening, and the costs of readmission and revision THA.
Improving patient outcomes is an important goal of any orthopaedic intervention. With new bundled payment systems in place, reduction in overall cost of care is becoming increasingly important. New innovations in technology and research should strive for improved patient outcomes with net lower cost.
Although considered a successful operation in terms of patient satisfaction and cost effectiveness, hospital costs associated with total joint replacement exceeded $19 billion in 2010. With the number of total joint replacements expected to increase dramatically in the coming years, the importance of maximizing outcomes while decreasing overall cost is more important now than ever before.
Historically, most orthopaedic research has focused on improving implant durability through design modifications and material advances. This article provides an argument in favor of redirecting efforts toward other known arthroplasty complications, specifically toward reducing periprosthetic joint infections.
Ryan Roach, MD is an orthopaedic surgery resident at NYU Langone Medical Center – Hospital for Joint Diseases, New York, New York. Ajit Deshmukh, MD is an Assistant Professor of Orthopaedic Surgery, Division of Adult Reconstruction, Department of Orthopaedic Surgery, at NYU Langone Medical Center – Hospital for Joint Diseases, New York, New York.