Care Setting and State-level Predictors of Unicompartmental Knee Arthroplasty Price Variation Across the United...

Unicompartmental knee arthroplasty (UKA) is a cost-conscious, minimally invasive surgical option for patients with isolated compartment disease. Because UKA is an increasingly common and outpatient procedure, it serves as a model for evaluating the effects of hospital price transparency legislation. This study investigated the association between state-level policy and socioeconomic factors on hospital-reported UKA pricing. This cross-sectional analysis included hospital-reported gross charges for UKA (CPT 27446) from the Turquoise Health database across the 50 states in the United States. Multivariable linear regression assessed associations between UKA price and state partisanship (0-5 scale: Democrat to Republican), Certificate of Need (CON) laws, Medicaid expansion, and care setting (inpatient or outpatient). A secondary analysis of North Carolina hospitals assessed the influence of Area Deprivation Index and urbanization on within-state price variation. Among 141,541 reported UKA prices from 2,522 facilities, lower gross charges were associated with states with Republican affiliation (β = $286.9; p < 0.0001), presence of CON laws (β = - $799.8, p < 0.0001), and outpatient settings (β = - $386.0, p < 0.0001). Medicaid expansion was associated with increased pricing (β = +$468.3, p < 0.0001). In North Carolina, hospitals in high ADI counties listed significantly lower prices (β = - $2,727.4, p = 0.014); urban location was not significant. Gross charges for UKA vary by state policy environment and care setting. Lower prices were observed in states with Republican leaning, CON laws, high-deprivation regions, and outpatient settings, whereas higher prices were associated with Medicaid expansion. These findings highlight the complex role of policy in shaping equitable access to affordable orthopedic care.