Back
 OJO  Vol.2 No.2 , June 2012
Cost/Charges Appraisal and Clinical Evidence Considerations in Orthopaedic Literature
Abstract: Introduction: Health care expenditures in the United States have rapidly risen in the last decade, including orthopaedic induced expenses. This paper addresses the methodology by which clinical evidence is obtained to better direct orthopaedic practice and encourage cost-efficiency. Questions: We conducted this inquiry to answer these questions: 1) Have orthopaedic expenses increased in the United States? 2) Does high grade clinical evidence prevail in orthopaedic literature? 3) Does clinical orthopaedic research include cost in outcome analysis? 4) Does the increase in orthopaedic expenses correlate with cost awareness in orthopaedic literature? Methods: The aggregate hospital charges (national bill) associated with three major orthopaedic procedures were extracted from the Nationwide Inpatient Sample (NIS) website (data available from 1997 to 2008). Using the biomedical search engine PubMed (launched 1996), different types of literature pertaining to general orthopaedic and three major orthopaedic procedures—hip replacement, knee replacement, and spine fusion, were probed regarding level of evidence and cost inclusion. Results: From 1997 to 2008, the national hospital charges for spine fusion increased by 10.4 times while for total knee replacement it increased by 4.9 times and for total/partial hip replacement by 3.4 times. From 1996 to 2010, PubMed indexed 1113 randomized controlled trials (RCTs) related to hip replacement, 942 related to knee replacement and 357 related to spine fusion. During the same period, RCTs related to total/partial hip replacement, total knee replacement and spine fusion procedures have increased by 3 times, 6 times, and 3.4 times, respectively. The percentage of blinded RCTS with cost analysis among all RCTs related to each procedure were 0%, 0.001% and 0.003% for total/partial hip replacement, total knee replacement and spine fusion procedures respectively. The correlation in the national hospital charges of all three procedures individually and their level I literature with cost element was not significant except for spine fusion. Conclusion: To improve literature shortfalls, substantial attention needs to be focused toward more rigorous studies which consider cost efficiency.
Cite this paper: J. Robinson III, M. Sami Walid, W. E. Floyd and J. Robinson Jr., "Cost/Charges Appraisal and Clinical Evidence Considerations in Orthopaedic Literature," Open Journal of Orthopedics, Vol. 2 No. 2, 2012, pp. 40-46. doi: 10.4236/ojo.2012.22008.
References

[1]   Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, “National Health Care Expenditures Data,” January 2010.

[2]   E. J. Emanuel and V. R. Fuchs, “The Perfect Storm of Over-utilization,” The Journal of the American Medical Association, Vol. 299, No. 23, 2008, pp. 2789-2791. doi:10.1001/jama.299.23.2789

[3]   E. Stranges, C. A. Russo and B. Friedman, “Procedures with the Most Rapidly Increasing Hospital Costs, 2004-2007: Statistical Brief #82,” In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Agency for Health Care Policy and Research (US), Rockville, 2006-2009 December.

[4]   S. Ryan, L. Perrier and R. G. Sibbald, “Searching for Evidence-Based Medicine in Wound Care: An Introduction,” Ostomy Wound Management, Vol. 49, No. 11, 2003, pp. 67-75.

[5]   D. L. Sackett, “The Fall of Clinical Research and the Rise of Clinical-Practice Research,” Clinical and Investigative Medicine, Vol. 23, No. 6, 2000, pp. 379-381.

[6]   D. A. Sharan, J. Genuario, S. Mehta, S. Kusuma, A. Ranawat, R. Nunley and S. L. Weinstein, “Current Issues in Health Policy: A Primer for the Orthopaedic Surgeon,” Journal of the American Academy of Orthopaedic Surgery, Vol. 15, No. 2, 2007, pp. 76-86.

[7]   H. A. Vallier, B. M. Patterson, C. J. Meehan and T. Lombardo, “Orthopaedic Traumatology: The Hospital Side of the Ledger, Defining the Financial Relationship between Physicians and Hospitals,” Journal of Orthopaedic Trauma, Vol. 22, No. 4, 2008, pp. 221-226. doi:10.1097/BOT.0b013e31815e92e5

[8]   J. S. Cossman and D. Street, “Policy, Autonomy, and Physician Satisfaction,” Journal of Health Care for the Poor and Un-derserved, Vol. 21, No. 3, 2010, pp. 898-912. doi:10.1353/hpu.0.0327

[9]   R. Vesely, “Thinking Smaller in 2011. Insurers Expect Lower Profits as They Cope with Higher Costs, New Regulations,” Modern Healthcare, Vol. 41, No. 6, 2011, p. 14.

[10]   D. J. Do-negan, T. W. Kim and G. C. Lee, “Publication Rates of Presentations at an Annual Meeting of the American Academy of Orthopaedic Surgeons,” Clinical Orthopaedics and Related Research, Vol. 468, No. 5, 2010, pp. 1428-1435. doi:10.1007/s11999-009-1171-5

 
 
Top