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October 18, 2013

Knee Replacement Surgery’s Savings to Society

With all of the scrutiny that physicians have faced over the last several years with respect to their involvement and collaboration with industry, many forget about the critical improvements in patient health that such relationships foster.

For example, a recent study published in The Journal of Bone & Joint Surgery suggests that patients over time can reap nearly $40,000 on average in "societal savings" -- the money they earn from being able to work instead of being on disability -- from total knee-replacement surgery, which is more than the roughly $21,000 cost of the procedure.

In fact, the study found that all the total knee replacements performed in 2009 in the United States saved an estimated $12 billion in lifetime societal savings with most of that benefitting patients and employers, reported Orthopedics Today.

"We know that when a knee replacement is done on patients at the appropriate time, it adds tremendous value to their lives. It gets them back to work and back to their families. It improves their quality of life and allows them to be productive and active again," John R. Tongue, MD, American Academy of Orthopaedic Surgeons (AAOS) past-president, stated in an AAOS press release. "But until now, that value has been hard to quantify. This study allows patients to see the big picture of the effect on their daily lives and in the long term."

Tongue noted that four (4) additional studies analyzing the financial benefits of other orthopedic procedures are in the pipeline.

Tongue and colleagues used a Markov model to estimate the direct and indirect cost savings for the more than 600,000 total knee replacements (TKR) for end-stage knee osteoarthritis (OA) during 2009 in the United States. They measured direct costs, which included expenditures for surgical and nonsurgical end-stage knee OA treatment, as well as indirect costs, including lost wages, lower earnings and disability payments, according to the abstract.

The investigators found a lifetime overall net benefit for TKR of $18,930 per patient. To determine this, they subtracted the mean increase in indirect lifetime savings of $20,635 that they found from the $39,565 societal savings associated with reduced indirect costs from TKR that they calculated.

Eighty-five percent of the savings accrued were from "increased employment and earnings," and the other 15% in savings was from a reduced number of disability payments and fewer missed days of work, Tongue and colleagues concluded.

"With the new model we created for this study, we have opened the door to evaluate societal benefit for other types of health care services as well, which is truly exciting," Lane Koenig, PhD, a study author and health care economist, from Rockville, Md., stated in the release. "The benefit of successful treatment of bone and joint conditions in the long term is known by the patients who've been through it, but these data offer evidence on the societal effects that will add to the conversation people are having about improved, cost-conscious health care."

Interestingly, the study comes at a time when the costs of procedures such as knee and hip replacements come under scrutiny, particularly in the era of comparative effectiveness researcher. In other words, many have begun to question whether expensive surgeries actually save patients and society money versus other alternatives such as physical therapy. For example, another study last month found a staggering disparity between what hospitals charge for the operations, and little connection between price and the quality of outcome, reported CNBC.

This study, however, may dispel concerns about the costs of these procedures. The research will bring clarity to those who have questioned the value of knee replacements and change the conversation about whether such surgery is worth it.

Mary Ann Tuft, a 78-year-old who runs Tuft & Associates, a Chicago-based boutique executive search firm, underwent total knee replacement in 2005 after years of pain.

"I found it difficult to walk down the block," Tuft said. She began avoiding networking events such as cocktail parties "because you stand all the time," she added. "After a decade, I had enough of it, and I just knew that I had to do something." Tuft raved about the results of her surgery, saying she's much more mobile and barely aware of the fact that she has an artificial joint. "I probably wouldn't have been able to function" much longer, she said.

"This is eight years later, and my business has probably grown three or four times since," said Tuft, adding that the firm's annual billings top $1 million. "We have more business now that we've ever had."


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