Arthroplasty implants and materials: Cost awareness and value perception.

Arthroplasty procedures are commonly performed and contribute to healthcare expenditures seen in the United States. Surgical team members may make selections among implants and materials without always knowing their relative cost. The current study reports on a survey aimed to investigate the perceptions of an academic group about the relative cost and value of commonly used operating room implants and materials related to joint arthroplasty cases using 10 matched pairs of items. Of the 124 persons eligible to take the survey, 102 responded (response rate of 82.3%) including attendings, fellows, residents, physician assistants (PAs), advanced practice registered nurses (APRNs) and registered nurses (RNs). On average for the ten pairs of items, the more expensive items were correctly selected by 90.2+/-13.9% (mean+/- standard deviation) of respondents with a range from 54.9% to 100%. Of note, the cost differences were significantly overestimated for 8/10 item pairs. The majority of respondents perceived the more expensive item as the item with the higher clinical value for 9/10 item pairs. Most arthroplasty attendings (91.3%) indicated willingness to use the less expensive item of two similar items. Nonetheless, 17.9% of fellows, residents, PAs, APRNs and RNs indicated that they would not feel comfortable suggesting using the less expensive item. Although attending arthroplasty surgeons stated a desire to consider costs, a knowledge deficit with regards to identifying the extent of cost differences was identified, and a significant portion of the surgical support team reported being hesitant to suggest less expensive options.
Competing Interests: We have read the journal’s policy and the authors of this manuscript have the following competing interests: • Jonathan Grauer: financial support publishing role in North American Spine Society; editor-in-chief for North American Spine Surgery Journal; board member/committee appointments for North American Spine Society; board member/committee appointments for Lumbar Spine Research Society • Lee Rubin: paid consultant for DePuy Synthes; paid consultant for ConvaTEC; stock or stock options in 3D Surgical, Inc.; royalties, financial or material support from SLACK, Inc.; royalties, financial or material support from Johns Hopkins University Press; Medical/Orthopaedic publications editorial/governing board-Journal of Arthroplasty; Medical/Orthopaedic publications editorial/governing board-Arthroplasty Today; Medical/Orthopaedic publications editorial/governing board-Reconstructive Review; board member/committee appointments for AAOS; board member/committee appointments for AAHKS; board member/committee appointments for ABOS. This does not alter our adherence to PLOS ONE policies on sharing data and materials.