RESUMO
BACKGROUND: As value becomes a larger component of heath care decision making, cost data can be evaluated for regional and physician variation. Value is determined by outcome divided by cost, and reducing cost increases value for patients. "Third-party spend" items are individual selections by surgeons used to perform procedures. Cost data for third-party spend items provide surgeons and hospitals with important information regarding care value, potential cost-saving opportunities, and the total cost of ownership of specific clinical decisions. PURPOSE: To perform a cost review of isolated rotator cuff repair within a regional 7-hospital system and to document procedure cost variation among operating surgeons. STUDY DESIGN: Economic and decision analysis; Level of evidence, 4. METHODS: Current Procedural Terminology (CPT) codes were used to retrospectively identify subjects who received an isolated rotator cuff repair within a 7-hospital system. Cost data were collected for clinically sensitive third-party spend items and divided into 4 cost groups: (1) suture anchors, (2) suture-passing devices and needles, (3) sutures used for cuff repair, and (4) disposable tools or instruments. RESULTS: A total of 62 isolated rotator cuff repairs were performed by 17 surgeons over a 13-month period. The total cost per case for clinically sensitive third-party spend items (in 2015 US dollars) ranged from $293 to $3752 (mean, $1826). Four surgeons had a mean procedure cost that was higher than the data set mean procedure cost. The cost of an individual suture anchor ranged from $75 to $1775 (mean, $403). One disposable suture passer was used, which cost $140. The cost of passing needles ranged from $140 to $995 (mean, $468). The cost per repair suture (used to repair cuff tears) varied from $18 to $298 (mean, $61). The mean suture (used to close wounds) cost per case was $81 (range, $0-$454). A total of 316 tools or disposable instruments were used, costing $1 to $1573 per case (mean, $624). CONCLUSION: This study demonstrates significant cost variation with respect to cost per case and cost of individual items used during isolated rotator cuff repair. Suture anchors represent the most expensive and variable surgeon-directed cost. The wide cost variation seen in all cost categories illustrates both the effect of surgeon choice in procedure cost and the opportunity for significant cost savings in cases of isolated rotator cuff repair. Engaging surgeons in discussion on cost can positively influence the value of care provided to patients if costs can be reduced without affecting the quality of patient outcomes.
RESUMO
BACKGROUND: Examination of value in health care has become a national priority in the United States. Regional variation in health care costs is an area of focus among national policy experts. Procedural cost data can be used to provide physicians with information to evaluate costs and value. PURPOSE: To perform a cost review for anterior cruciate ligament (ACL) surgery to document the degree of variation in costs for ACL reconstruction. STUDY DESIGN: Economic and decision analysis; Level of evidence, 4. METHODS: A procedural cost review was performed for isolated ACL reconstructions within a 22-surgeon, 7-hospital system. Five consistent cost categories under the influence of the surgeon were identified and were analyzed for cost variation among surgeons: tibial fixation, femoral fixation, graft choice, sutures, and tools or disposable instruments. RESULTS: For these 5 categories, the total costs to perform an ACL reconstruction (in 2013 US dollars) ranged from $392.80 to $4670.31, a difference of $4277.51 and a mean of $2039.09. Tibial fixation costs ranged from $95.00 to $760.00 (mean, $293.52). Femoral fixation ranged from $95.00 to $865.00 (mean, $367.14). The graft cost ranged from $1275.00 to $2545.75 (mean, $1976.43). Suture prices for each individual suture varied from $1.19 to $46.00 (mean, $18.26). Tools and disposable supplies ranged from $40.10 to $2136.00 (mean, $452.33). CONCLUSION: There were substantial differences in ACL reconstruction costs in the implant and disposable instruments categories. As health systems and physicians collaborate to improve health care quality and value for patients, information on cost variation will be important. Rational variation in health care cost is appropriate, reflecting variation due to the unique requirements of procedures and patient-centered care. Irrational variations in procedural costs are those that do not add additional value.
