Abstract：
BACKGROUND:Total hip replacement (THR) must be managed in a more sustainable manner. More cost-effective surgical techniques and the centralization/regionalization of services are two solutions. The former requires an assessment of newer minimally invasive and muscle-sparing surgical techniques. The latter necessitates an effective volume-outcome (VO) relationship. Prior studies have failed to evaluate and control for the VO relation. OBJECTIVE:The objective of this study was to evaluate the relative cost and outcome effectiveness of two minimally invasive and one muscle-sparing techniques while evaluating and controlling for a potentially endogenous VO relation. METHODS:An all payer claims database for all THR performed in Maine in 2011 was used. The cost and outcome effectiveness of newer minimally invasive (modified Hardinge) and muscle-sparing (modified Watson-Jones) techniques were compared with the standard bearer posterior minimally invasive method. Using regression analysis, the outcomes analyzed were as follows: total costs, length of hospital stay, nursing care and home discharges, and use of physical therapy. Regression analysis was also used to evaluate and control for VO effects. RESULTS:(1) Newer muscle-sparing and minimally invasive approaches are substantially more effective; (2) irrespective of technique, higher volume surgeons are more effective; (3) technique-specific VO effects for more complex techniques exist and show substantial savings when yearly volume exceeds 30-50; and (4) the anterolateral muscle-sparing technique is accessible to the average surgeon. CONCLUSION:Reliance on newer surgical techniques and centralization/regionalization of THR services can reduce costs.
journal_name
Appl Health Econ Health Policyjournal_title
Applied health economics and health policyauthors
Goldstein JP,Babikian GM,Rana AJ,Mackenzie JA,Millar Adoi
10.1007/s40258-016-0260-3subject
Has Abstractpub_date
2016-12-01 00:00:00pages
703-718issue
6eissn
1175-5652issn
1179-1896pii
10.1007/s40258-016-0260-3journal_volume
14pub_type
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