High comorbidity burden may negatively impact cost-effectiveness of TKA
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Key takeaways:
- High comorbidity burden was associated with reduced cost-effectiveness of TKA vs. healthy patients.
- Increased costs of TKA in patients with high comorbidity burden may not be met with increased hospital revenue.
Inpatient total knee arthroplasty for patients with a high comorbidity burden may not be cost-effective, as published results showed increased procedural costs were not met with increased hospital revenue in this patient population.
In addition, results showed increased readmission rates and length of stay may further increase the financial burden of TKA in patients with high comorbidity burden (HCB).
“Policymakers and [advocates need] to see that if we do not change the way we compensate for [patients with high comorbidity] and make sure they are also financially soluble, meaning their contribution margin per patient is positive, these patients will have an access to care problem,” Ran Schwarzkopf, MD, professor of orthopedic surgery at NYU Langone Orthopedic Hospital, told Healio.
Schwarzkopf and colleagues performed a retrospective review of data from 10,647 patients who underwent an elective, inpatient TKA between January 2012 and December 2021. Among the cohort, 1,186 patients were deemed to have HCB and 9,461 patients were deemed not to have HCB. After propensity score matching, the final cohort included 768 patients with HCB and 768 patients without HCB.
According to the study, HCB was defined as a Charlson Comorbidity Index of 5 or more.
Compared with patients without HCB, patients with HCB had a 15.6% increase in total costs, a 12.5% increase in direct costs and a 19.9% decrease in contribution margins per inpatient episode.
“That means it is not financially sustainable treating these patients with the current reimbursement,” Schwarzkopf said.
However, Schwarzkopf and colleagues found no statistically significant difference in hospital revenue per episode for patients with HCB vs. patients without HCB.
Schwarzkopf and colleagues also found patients with HCB had a significantly longer length of stay (3.3 days vs. 2.7 days) and significantly greater 90-day readmission rate (4.7% vs. 2.1%) compared with patients without HCB.
According to Schwarzkopf, as orthopedic surgery is driven to outpatient centers and ASCs, patients with HCB will be seen as inappropriate candidates and left to be treated at academic institutions.
“But all of these patients are not financially soluble,” Schwarzkopf said. “That means the hospitals will be losing money on every patient they treat, and they will not be able to continue treating these patients. This will cause either hospitals to be unable to provide care or close due to financial losses or patients that will not get treated anymore because no one can treat them financially.”
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