Reducing arthroplasty costs

The paper by Johnston and his colleagues in this issue (page 445) on reducing arthroplasty costs through vendor contracts deserves a wide audience. This Edmonton group has initiated and sustained a viable methodology, which creates a win-win scenario for patients, surgeons, health care providers and prostheses manufacturers. It could act as a blueprint for other centres that are also facing cost constraints.

There are some important points to consider.

The process was open, the specific variables were identified for all potential bidders and the evaluation committee comprised a majority of peer-chosen orthopedic suregeons. As be ne fits were identified and made available to all potential partners in the equation, the project continued to be a success. Important allowances were made for new advances and revision procedures not included in this process.

As the practice of joint arthroplasty continues to improve, the numbers necessary to demonstrate clinically and statistically significant differences between arthroplasty components are becoming larger. This means that an individual surgeon’s results are un-likely ever to show a significant difference among components and that groups of surgeons, by pooling their results, will be able to demonstrate a significant difference and have considerable impact on prosthesis selection.

Outcomes collected on behalf of a group allow for individual comparisons or surgical outcomes to be analysed and improved upon. Ten-year results are more likely to be collected when independent study research personnel, reporting to the group rather than to individual surgeons, can follow up patients for that length of time.

The process was also acceptable because with the use of an audited wait list demonstrating significant wait time for joint arthroplasty, the administration was able to free more resources to add to the savings achieved and allow more patients to undergo the operation.

This process is also something that industry should support. Manufacturers no longer have to answer to individual surgeons but to groups of surgeons, and this undoubtedly is a source of some cost savings. They will also be able to get significant results with respect to their arthroplasty products quicker with a group of surgeons than with individuals.

There is one caveat for the future. If a new implant is designed and implanted under trial conditions and demonstrates significantly superior results, then the administration must be prepared to pay more for such an implant, because the costs of proving its efficacy are naturally going to increase if the new product is subjected to a 10-year randomized, controlled study.

We should now ask that such an accounting of costs and outcomes be applied to other areas to enhance efficiency and improve outcomes in other surgical and nonsurgical specialties.