Skip to main content
Journal cover image

Determining the Cost-Savings Threshold and Alignment Accuracy of Patient-Specific Instrumentation in Total Ankle Replacements.

Publication ,  Journal Article
Hamid, KS; Matson, AP; Nwachukwu, BU; Scott, DJ; Mather, RC; DeOrio, JK
Published in: Foot Ankle Int
January 2017

BACKGROUND: Traditional intraoperative referencing for total ankle replacements (TARs) involves multiple steps and fluoroscopic guidance to determine mechanical alignment. Recent adoption of patient-specific instrumentation (PSI) allows for referencing to be determined preoperatively, resulting in less steps and potentially decreased operative time. We hypothesized that usage of PSI would result in decreased operating room time that would offset the additional cost of PSI compared with standard referencing (SR). In addition, we aimed to compare postoperative radiographic alignment between PSI and SR. METHODS: Between August 2014 and September 2015, 87 patients undergoing TAR were enrolled in a prospectively collected TAR database. Patients were divided into cohorts based on PSI vs SR, and operative times were reviewed. Radiographic alignment parameters were retrospectively measured at 6 weeks postoperatively. Time-driven activity-based costing (TDABC) was used to derive direct costs. Cost vs operative time-savings were examined via 2-way sensitivity analysis to determine cost-saving thresholds for PSI applicable to a range of institution types. Cost-saving thresholds defined the price of PSI below which PSI would be cost-saving. A total of 35 PSI and 52 SR cases were evaluated with no significant differences identified in patient characteristics. RESULTS: Operative time from incision to completion of casting in cases without adjunct procedures was 127 minutes with PSI and 161 minutes with SR ( P < .05). PSI demonstrated similar postoperative accuracy to SR in coronal tibial-plafond alignment (1.1 vs 0.3 degrees varus, P = .06), tibial-plafond alignment (0.3 ± 2.1 vs 1.1 ± 2.1 degrees varus, P = .06), and tibial component sagittal alignment (0.7 vs 0.9 degrees plantarflexion, P = .14). The TDABC method estimated a PSI cost-savings threshold range at our institution of $863 below which PSI pricing would provide net cost-savings. Two-way sensitivity analysis generated a globally applicable cost-savings threshold model based on institution-specific costs and surgeon-specific time-savings. CONCLUSIONS: This study demonstrated equivalent postoperative TAR alignment with PSI and SR referencing systems but with a significant decrease in operative time with PSI. Based on TDABC and associated sensitivity analysis, a cost-savings threshold of $863 was identified for PSI pricing at our institution below which PSI was less costly than SR. Similar internal cost accounting may benefit health care systems for identifying cost drivers and obtaining leverage during price negotiations. LEVEL OF EVIDENCE: Level III, therapeutic study.

Duke Scholars

Published In

Foot Ankle Int

DOI

EISSN

1944-7876

Publication Date

January 2017

Volume

38

Issue

1

Start / End Page

49 / 57

Location

United States

Related Subject Headings

  • Tomography, X-Ray Computed
  • Tibia
  • Talus
  • Radiography
  • Orthopedics
  • Operative Time
  • Middle Aged
  • Male
  • Joint Prosthesis
  • Imaging, Three-Dimensional
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Hamid, K. S., Matson, A. P., Nwachukwu, B. U., Scott, D. J., Mather, R. C., & DeOrio, J. K. (2017). Determining the Cost-Savings Threshold and Alignment Accuracy of Patient-Specific Instrumentation in Total Ankle Replacements. Foot Ankle Int, 38(1), 49–57. https://doi.org/10.1177/1071100716667505
Hamid, Kamran S., Andrew P. Matson, Benedict U. Nwachukwu, Daniel J. Scott, Richard C. Mather, and James K. DeOrio. “Determining the Cost-Savings Threshold and Alignment Accuracy of Patient-Specific Instrumentation in Total Ankle Replacements.Foot Ankle Int 38, no. 1 (January 2017): 49–57. https://doi.org/10.1177/1071100716667505.
Hamid KS, Matson AP, Nwachukwu BU, Scott DJ, Mather RC, DeOrio JK. Determining the Cost-Savings Threshold and Alignment Accuracy of Patient-Specific Instrumentation in Total Ankle Replacements. Foot Ankle Int. 2017 Jan;38(1):49–57.
Hamid, Kamran S., et al. “Determining the Cost-Savings Threshold and Alignment Accuracy of Patient-Specific Instrumentation in Total Ankle Replacements.Foot Ankle Int, vol. 38, no. 1, Jan. 2017, pp. 49–57. Pubmed, doi:10.1177/1071100716667505.
Hamid KS, Matson AP, Nwachukwu BU, Scott DJ, Mather RC, DeOrio JK. Determining the Cost-Savings Threshold and Alignment Accuracy of Patient-Specific Instrumentation in Total Ankle Replacements. Foot Ankle Int. 2017 Jan;38(1):49–57.
Journal cover image

Published In

Foot Ankle Int

DOI

EISSN

1944-7876

Publication Date

January 2017

Volume

38

Issue

1

Start / End Page

49 / 57

Location

United States

Related Subject Headings

  • Tomography, X-Ray Computed
  • Tibia
  • Talus
  • Radiography
  • Orthopedics
  • Operative Time
  • Middle Aged
  • Male
  • Joint Prosthesis
  • Imaging, Three-Dimensional