COST EFFECTIVENESS OF COMPUTER NAVIGATION IN TOTAL JOINT ARTHROPLASTY IN THE MEDICARE POPULATION

Abstract

Computer navigation in total joint arthroplasty has been shown to be effective in improving the radiographic outcome in patients undergoing both hip and knee arthroplasty. However, critics have argued that the required capital equipment and added time to perform the procedure is cost prohibitive. To test this hypothesis, we compared our hospital discharge experience with computer navigation to national standards published by the Agency for Healthcare Research and Quality for the years 2004 and 2005

In the AHRQ database the average length of stay for DRG 209 in 2004 and 2005 respectively, in the Midwest region was 4.6 days and 4.3 days, with a mean charge of $27,403 and $27,948, with only 40% and 45%, of patients discharged to home with or without home health care. In 2004 and 2005, the senior author performed 125 and 117 Medicare primary hip and knee replacements, respectively, with computer navigation with a mean length of stay of 2.9 days and 2.8 days, with charges of $22,134 and $24,612, and 63% and 71% discharged to home.

On a pure charge basis, the senior author experience a decreased overall charge compared to published data. Even if the entire cost of the navigation system in our system $204,000 was spread equally over only the Medicare patients over the two year period, the additional $842/case still results in a case charge below published data.

Based on the senior author’s experience with hospitalization cost, length of stay and discharge disposition, computer navigation in total joint replacement is not associated with an increased cost/case and may result in dramatically lower indirect costs due to shorter length of stay and increased number of discharges to home compared to published regional Medicare discharge data.