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Projected Savings Associated with Lowering the Risk of Total Hip Arthroplasty Revision Due to Dislocation in Patients
Stacey J Ackerman1, Jonathan M Vigdorchik2, Breana R Siljander2,3
1Department of Biomedical Engineering, Johns Hopkins University, San Diego, CA, USA.
Insights
Reducing revision total hip arthroplasty (rTHA) risk in patients with spinopelvic pathology (SPP) could save US payers millions. A 10% risk reduction could yield $233M for Medicare and $395M for all payers over 10 years.
Area of Science:
- Orthopedic surgery
- Health economics
- Biostatistics
Background:
- Total hip arthroplasty (THA) is a common procedure, but spinopelvic pathology (SPP) increases revision THA (rTHA) risk due to dislocation.
- Strategies like dual-mobility implants and surgical navigation aim to reduce instability in THA patients with SPP.
Purpose of the Study:
- Estimate the population size of primary THA (pTHA) patients with SPP who undergo rTHA due to dislocation.
- Quantify the economic burden of rTHA in this population.
- Project 10-year savings for US payers by reducing rTHA risk in pTHA patients with SPP.
Main Methods:
- Budget impact analysis from a US payer perspective.
- Utilized data from literature, AAOS Registry, CMS MEDPAR, and NIS.
- Adjusted expenditures to 2021 USD and performed sensitivity analyses.
Main Results:
- Estimated 2021 target population: 5040 for Medicare, 8003 for all-payer.
- Annual rTHA expenditures: $185M (Medicare), $314M (all-payer).
- Projected 2022-2031 rTHA procedures: 63,419 (Medicare), 100,697 (all-payer).
- 10% risk reduction could save $233M (Medicare) and $395M (all-payer) over 10 years.
Conclusions:
- A modest reduction in rTHA risk for pTHA patients with SPP can lead to significant payer savings.
- Implementing strategies to mitigate dislocation risk improves healthcare quality and economic outcomes.
Purpose:
In the United States (US), total hip arthroplasty (THA) is the most common hospital inpatient operation among Medicare beneficiaries and is ranked fourth when considering all payers. Spinopelvic pathology (SPP) is associated with an increased risk of THA revision (rTHA) due to dislocation. Several strategies have been proposed to mitigate the risk of instability in this population, including use of dual-mobility implants, anterior-based surgical approaches, and technology-assistance (digital 2D/3D pre-surgical planning, computer navigation, and robotic assistance). For primary THA (pTHA) patients with SPP who subsequently undergo rTHA due to dislocation, we aimed to estimate (1) target population size; (2) economic burden; and (3) 10-year projected savings to the US payer of lowering the risk of rTHA due to dislocation among pTHA patients with SPP.
Methods:
A budget impact analysis from the US payer perspective was undertaken using published literature; American Academy of Orthopaedic Surgeons American Joint Replacement Registry 2021 Annual Report; Centers for Medicare & Medicaid Services MEDPAR 2019; and National (Nationwide) Inpatient Sample (NIS) 2019. Expenditures were inflation-adjusted to 2021 US dollars using the Medical Care component of the Consumer Price Index. Sensitivity analyses were performed.
Results:
The target population size in 2021 was estimated at 5040 (range, 4830-6309) for Medicare (fee-for-service plus Medicare Advantage) and 8003 (range, 7669-10,018) for all-payer. Annual rTHA episode-of-care (through 90 days) expenditures for Medicare and all-payer were $185 million and $314 million, respectively. Using a 4.14% compound annual growth rate from NIS, the estimated number of applicable rTHA procedures that will be performed from 2022-2031 was 63,419 Medicare and 100,697 all-payer. With each 10% reduction in relative risk of rTHA due to dislocation, Medicare and all-payer could save $233 million and $395 million, respectively, over a 10-year period.
Conclusion:
Among pTHA patients with spinopelvic pathology, a modest reduction in the risk of rTHA due to dislocation could achieve substantial cumulative savings to payers while improving healthcare quality.
