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AAHS #2 Are Surgeons Price-Sensitive? A Randomized Controlled Study on Factors Driving Surgeon Implant Selection
Amy Wasterlain, MD1; Eitan Melamed, MD2; Raj Karia, MPH1; Kathryn Birenbaum, MD1; John T. Capo, MD1
1NYU Hospital for Joint Diseases, New York, NY; 2Johns Hopkins Bayview Medical Center, Baltimore, MD

Introduction: Surgical costs are under scrutiny by the public, and healthcare providers are increasingly being held accountable for containing medical costs. Surgical implants are often the largest component of total procedure cost, yet previous studies have revealed that surgeons' knowledge of implant prices is poor. Our study aims to (1) understand the drivers behind implant choice, and (2) assess whether educating surgeons about implant costs affects their implant choices.

Methods: We surveyed 226 orthopaedic surgeons across 6 continents. The survey presented 8 clinical cases of upper extremity fractures with history and radiographs, followed by surgical implant options. Surgeons were randomized to receive either a version that included each implant's average selling price ("price-aware" group), or a version without any mention of price ("price-naive" group). Surgeons were asked to select a surgical implant and to rank factors affecting implant choice. Six cases offered different classes of implants (eg, Kirschner wires, volar locking plate, or spanning external fixator for a distal radius fracture). Two cases offered different implant models within the same class (eg, volar locking plate implants with fixed or variable angle screws). Descriptive statistics and univariate analyses were performed.

Results: Cost-effectiveness was ranked as the most important factor in implant selection by 19% of price-aware vs 6% of price-na´ve respondents. Familiarity with the implant was the most common reason for choosing an implant in both groups (35 vs 46%). Implant selection was similar between price-aware and price-na´ve surgeons for cases comparing different classes of implants (p=0.26), but it differed significantly for cases comparing models within the same implant class. When offered different models of distal radius volar locking plates, 25% of price-na´ve surgeons selected the most expensive plate vs only 7% of price-aware surgeons (p<0.001). Similarly, the most expensive distal humerus plate was selected by 25% of price-na´ve surgeons vs only 13% of price-aware surgeons (p=0.01). On average, price-aware surgeons selected implants that were 9-11% cheaper than price-na´ve surgeons.

Conclusions: Although price does not alter a surgeon's decision to use a certain class of implant (eg, locking plate vs external fixator), price awareness does significantly influence surgeons' choice of a specific implant model within a general class (eg, volar locking plates with different features). Merely including prices with a list of implant options increases surgeons' perception that price is important. This implies that a real, untapped opportunity exists to reduce surgical expenditures simply by enhancing surgeons' awareness of implant costs.

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