Does Transparency of Ankle Implant Costs Influence Surgeon Behavior?

Area of Science:

• Orthopaedic Surgery
• Health Economics
• Surgical Outcomes

Background:

• Ankle fractures are common, often requiring open reduction internal fixation (ORIF).
• Implant costs vary significantly for ORIF procedures.
• Lack of cost transparency is a perceived barrier to reducing implant expenses.

Purpose of the Study:

• To evaluate if increased transparency in ankle implant costs influences surgeon behavior.
• To determine if cost education impacts implant selection and associated expenses.

Main Methods:

• A surgeon-led study at a Level 1 trauma center reviewed 110 ankle fracture fixation cases (Dec 2021-Sep 2022).
• Monthly implant cost data was provided to surgeons from March-June 2022.
• A linear mixed model analyzed factors associated with cost changes; surgeon surveys were conducted.

Main Results:

• No significant mean cost difference was observed for unimalleolar (-$204.80) or bimalleolar (-$9.82) fractures post-education.
• Trimalleolar fractures showed a slight mean cost increase (+$94.47).
• Fracture pattern was the only significant factor associated with implant costs (P<.01); only 2/7 surgeons decreased costs.

Conclusions:

• Most surgeons reported being influenced by cost education, but less than one-third demonstrated a change in practice.
• Increased cost transparency alone does not appear to significantly influence surgeon implant selection or reduce related costs.