Cost analysis of different fixation techniques for distal biceps ruptures using time-driven activity-based costing

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Health Economics

Background:

• Distal biceps brachii tendon ruptures are commonly treated with various fixation methods.
• Existing research indicates similar clinical outcomes across different fixation implants (buttons, screws, anchors).
• The economic impact of these diverse implants on day-of-surgery (DOS) costs remains largely unexamined.

Purpose of the Study:

• To analyze and compare the day-of-surgery (DOS) costs associated with different implant types used for distal biceps tendon repairs.
• To utilize time-driven activity-based costing (TDABC) to accurately assess the financial implications of various fixation methods.

Main Methods:

• A retrospective review of 433 patients undergoing primary distal biceps repair from January 2018 to May 2025.
• Exclusion of revision surgeries, prior procedures, or incomplete costing data.
• Evaluation of patient demographics, implant types, operative details, anesthesia, retear rates, and DOS costs, analyzed using descriptive statistics, t-tests, Mann-Whitney U tests, and linear regressions.

Main Results:

• The average total DOS cost was $2,146.70, with significant variations based on fixation technique (p=0.002).
• Suture anchors were associated with the lowest DOS costs, while buttons and screws incurred the highest.
• Operative time and total implant cost were major cost drivers, explaining 80.8% of total DOS cost variance.

Conclusions:

• Suture anchors represent a potentially more cost-effective option for distal biceps tendon repair compared to buttons and screws.
• Fixation type, operative time, implant manufacturer, anesthesia, and patient age significantly influence DOS costs.
• These findings support informed, cost-aware decision-making for surgeons in the context of value-based orthopedic care.