Director, Epidemiology & RWDS Johnson & Johnson, United States
Background: The aging of the United States (US) population has led to an increased demand for total knee arthroplasty (TKA), resulting in significant pressures on the healthcare costs associated with TKA.
Objectives: Evaluate healthcare costs of TKA in the US from 2000 to 2021 from the hospital perspective and examine factors contributing to it.
Methods: The PREMIER Healthcare Database, a large US hospital-based, all-payer claims database containing more than 1,000 hospitals, was analyzed for total and department costs for patients that underwent primary TKA (N = 1,841,541) in both inpatient and outpatient settings from 2000-2021. TKA was identified using ICD 9 and ICD 10 procedure code. Hospital costs (expense incurred to deliver health care services to patients at the time of TKA) were inflation adjusted to 2021 USD. Generalized linear models with log link function were used to examine the associations between cost and various factors including patient demographics, marital status, insurance type, preoperative characteristics, technology use (robotic and computer assisted surgery), provider characteristics and admission year.
Results: In 2000, the mean total cost for one TKA episode was $22,551 (standard deviation (SD) = $9,571)). By 2021, the total cost decreased to $14,965 (SD = $7,722). Supply cost and operating room cost were consistently the top two cost categories (46% and 25% of mean total cost in all the years). From 2001 to 2021, the biggest decreases were lab cost (81%) and room and board cost (76%). Meanwhile, the percentage of inpatient TKAs among all TKAs decreased from 97% (n=14,510) to 34% (n=19,864). Mean cost related to TKA decreased from $22,616 to $17,060 (25%) for inpatient and from $20,671 to $13,884 (33%) for outpatient. Room and board cost decreased by 28% for inpatient and 99.95% for outpatient. Lab cost reduced by 71% for inpatient and 87% for outpatient. Supply cost for inpatient and outpatient TKA reduced by 36% and 30%, respectively. Operating room cost increased by 35% for inpatient and 26% for outpatient. Being in the age group 18-30 (vs. age group 61-70, b = 0.145, p < 0.001), male (b = 0.021, p < 0.001), single (vs. married, b = 0.022, p < 0.001), Black (vs. White, b = 0.051, p < 0.001), insured by Medicaid (vs. commercial, b=0.016, p < 0.001), inpatient (b=0.167, p < 0.001), having higher comorbidity index (b=0.025, p < 0.001), use of computer assisted TKA (b=0.032, p < 0.001), use of non-robotic TKA (b=0.014, p < 0.001), admitted in hospitals in Northeast US (vs. Midwest, b=0.150, p < 0.001) and in rural areas (b=0.022, p < 0.001) were associated with higher cost of TKA.
Conclusions: Hospital costs of primary TKA have decreased over the years with largest relative decreases in lab cost and room and board cost, coupled with the shift from inpatient TKA to outpatient TKA.
