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Economic Analysis of Implant Costs of Distal Radius Fracture
Suneel Bhat, MD, MPhil; Frederic Liss, MD; Pedro Beredjiklian, MD
Orthopaedics, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA

Introduction: Over the past two decades, advances in volar plate implant technology for treating distal radius fractures has lead to a paradigm shift in their management towards open reduction internal fixation. There are a number of different implant choices for surgical treatment of distal radius fractures, with selection often determined by surgeon preference or availability. Although no one volar plate has emerged that demonstrates superior outcomes, there are significant but underappreciated differences in implant cost which are absorbed by hospitals and surgical centers where the implants are used. We aimed to characterize the economic implications of implant selection in the surgical management of distal radius fractures.

Methods: Implant costs of five volar locking distal radius plate systems with screws were obtained from a mid-size community hospital surgicenter. Medicare facility reimbursement rates for CPT code 25607, 25608, and 25609 were obtained from the same center, and private facility reimbursement rates estimated to be 280% of Medicare reimbursement, as described in the literature. Facility per case fixed and variable costs were estimated at $900. Population distributions were derived from the US Census 2012 Population Estimates. Age and sex specific incidence of distal radius fracture were obtained from the literature. A unique stochastic decision tree model was built from derived probabilities and costs. A Monte Carlo simulation was performed with 100,000 iterations to achieve stable outcomes, and results analyzed with comparative statistics.

Results: Construct costs (distal radius plate with 3 locking screws and 3 non-locking screws) ranged from $1,228.95 to $2,029.00. Routine utilization of the lowest cost distal radius construct would result in operating surplus of $131,996,896 (95%CI $63,071,534 to $200,877,339), while the highest cost construct would result in an operating surplus of $66,725,459 (95%CI $9,899,271 to $124,474,700) annually in the US.

Discussion: In the universal effort to contain rising healthcare costs, value based purchasing are by necessity becoming integrated into clinical decision making by orthopaedic surgeons in the US. As a general rule, implant costs are included within facility reimbursement, therefore a positive operating margin is inversely related to implant cost. Utilization of lower cost plate and screw constructs can avoid a $65,271,437 financial loss annually in the US. Arming the orthopaedic surgeon with the realities of the cost of implant selection in the operative management of distal radius fractures will lead to better value based decision making, substantial cost savings to the US hospital system, and ultimately payers and patients.


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