Cost drivers in total hip arthroplasty: effects of procedure volume and implant selling price

Abstract

Total hip arthroplasty (THA), though a highly effective procedure for patients with end-stage hip disease, has become increasingly costly, both because of increasing procedure volume and because of the introduction and widespread use of new technologies. Data regarding procedure volume and procedure costs for THA were obtained from the National Inpatient Sample and other published sources for the years 1995 through 2005. Procedure volume increased 61% over the period studied. When adjusted for inflation, using the medical consumer price index, the average selling price of THA implants increased 24%. The selling price of THA implants as a percentage of total procedure costs increased from 29% to 60% during the period under study. The increasing cost of THA in the United States is a result of both increased procedure volume and increased cost of THA implants. No long-term outcome studies related to use of new implant technologies are available, and short-term results have been similar to those obtained with previous generations of THA implants. This study reinforces the need for a US total joint arthroplasty registry and for careful clinical and economic analyses of new technologies in orthopedics.