June 10, 2018
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Indirect cost savings of hip arthroscopy may reduce economic burden of FAI syndrome

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Hip arthroscopy for treatment of femoroacetabular impingement may provide economic benefits through indirect cost savings that exceed the direct costs of treatment compared with nonoperative management, according to results published in The American Journal of Sports Medicine.

Perspective from Benjamin G. Domb, MD

To identify cost-effectiveness of hip arthroscopy vs. nonoperative treatment of femoroacetabular impingement (FAI) syndrome, Richard C. Mather III, MD, MBA, and colleagues used CPT medical codes associated with FAI treatment to calculate direct costs. To measure indirect costs, they used patient-reported data of 102 patients who underwent arthroscopy and reimbursement records of 32,143 individuals aged between 16 years and 79 years who had information in a private insurance claims data set contained within the PearlDiver Patient Records Database. Researchers inferred indirect economic benefits of hip arthroscopy through regression analysis to estimate the statistical relationship between functional status and productivity before employing a simulation-based approach to estimate the change in productivity associated with the change in functional status between baseline and follow-up. They used one-, two- and three-way sensitivity analyses on all variables in the model to analyze cost-effectiveness, while they evaluated the impact of uncertainty in model assumptions through Monte Carlo analysis.

In the analysis of indirect costs, results showed a statistically significant increase of mean aggregate productivity of $8,968 after surgery. Compared with nonoperative treatment, researchers found hip arthroscopy had a mean cumulative total 10-year societal savings of $67,418 per patient through cost-effectiveness analysis, and a gain of 2.03 quality-adjusted life years. Hip arthroscopy had a mean cost estimated at approximately $23,120, according to the data, while nonoperative treatment had a mean cost estimated at approximately $91,602. Investigators noted the preferred cost-effective strategy in 99% of trials was hip arthroscopy.

“FAI syndrome creates substantial disability resulting in lower likelihood of employment and lower earnings,” Mather told Healio.com/Orthopedics. “Hip arthroscopy successfully addresses that disability generating economic benefit well in excess of the direct costs of treatment and more than treatment of ACL and rotator cuff tears and total knee arthroplasty. These findings are relevant when considering access to care for FAI syndrome and research priorities and funding as well as individual patient treatment decision making.” – by Casey Tingle

Disclosures: Mather reports he is a paid consultant for KNG Health Consulting and Stryker, and receives research support from Zimmer. Please see the full study for a list of all other authors’ relevant financial disclosures.