Heo Kevin, Karzon Anthony, Shah Jason, Ayeni Ayomide, Rodoni Bridger, Erens Greg A, Guild George N, Premkumar Ajay
Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia.
J Arthroplasty. 2024 Mar;39(3):612-618.e1. doi: 10.1016/j.arth.2023.08.062. Epub 2023 Aug 21.
With increasing numbers of revision total hip and total knee arthroplasties (rTHAs and rTKAs), understanding trends in related out-of-pocket (OOP) costs, overall costs, and provider reimbursements is critical to improve patient access to care.
A large database was used to identify 92,116 patients who underwent rTHA or rTKA between 2009 and 2018. The OOP costs associated with the surgery and related inpatient care were calculated as the sum of copayment, coinsurance, and deductible payments. Professional reimbursement was calculated as total payments to the principal physician. All monetary data were adjusted to 2018 dollars. Multivariate regressions evaluated the associations between costs and procedure type, insurance type, and region of service.
From 2009 to 2018, overall costs for rTHA significantly increased by 35.0% and overall costs for rTKA significantly increased by 32.3%. The OOP costs for rTHA had no significant changes, while OOP costs for rTKA increased by 20.1%, with patients on Medicare plans having the lowest OOP costs. Professional reimbursements, when measured as a percentage of overall costs, decreased significantly by 4.4% for rTHA and 4.0% for rTKA, with the lowest reimbursements from Medicare plans.
From 2009 to 2018, total costs related to rTHA and rTKA significantly increased. The OOP costs significantly increased for rTKA, and professional reimbursements for both rTHA and rTKA decreased relative to total costs. Overall, these trends may combine to create greater financial burden to patients and the healthcare system, as well as further limit patients' access to revision arthroplasty care.
随着全髋关节置换术和全膝关节置换术翻修手术（rTHA和rTKA）数量的增加，了解相关自付费用（OOP）、总成本以及医疗服务提供者报销费用的趋势对于改善患者获得医疗服务的机会至关重要。
使用一个大型数据库识别出2009年至2018年间接受rTHA或rTKA手术的92116名患者。与手术及相关住院治疗相关的OOP费用计算为自付额、共付额和免赔额支付的总和。专业报销费用计算为主治医生的总支付额。所有货币数据均调整为2018年美元。多变量回归评估了费用与手术类型、保险类型和服务地区之间的关联。
2009年至2018年，rTHA的总成本显著增加了35.0%，rTKA的总成本显著增加了32.3%。rTHA的OOP费用没有显著变化，而rTKA的OOP费用增加了20.1%，参加医疗保险计划的患者OOP费用最低。以占总成本的百分比衡量，rTHA的专业报销费用显著下降了4.4%，rTKA的专业报销费用显著下降了4.0%，医疗保险计划的报销费用最低。
2009年至2018年，与rTHA和rTKA相关的总成本显著增加。rTKA的OOP费用显著增加，rTHA和rTKA的专业报销费用相对于总成本均有所下降。总体而言，这些趋势可能共同给患者和医疗保健系统带来更大的经济负担，并进一步限制患者获得关节置换翻修手术治疗的机会。
