Cost and effectiveness of routine pathological examination of operative specimens obtained during primary total hip and knee replacement in patients with osteoarthritis.
BACKGROUND
The challenge of cost-efficiency is maintaining the quality of medical care while reducing costs and eliminating unnecessary practices. The purpose of this investigation was to evaluate the cost and effectiveness of routine pathological examination of surgical specimens from patients undergoing primary total hip or knee replacement for the treatment of osteoarthritis.


METHODS
Effectiveness was assessed by comparing clinical and pathological diagnoses associated with 1,234 consecutive primary total joint replacements (471 hip and 763 knee replacements) performed between 1992 and 1995 in one hospital in patients with the clinical diagnosis of osteoarthritis. Clinical and pathological diagnoses were considered concordant if they agreed, discrepant if they differed without a resultant change in patient management, and discordant if they differed with a resultant change in patient management. Cost identification was performed by determining charges, reimbursement, and costs in 1998-adjusted American dollars for both total hip and total knee replacement. The cost per health-effect was determined by calculating the cost per discrepant and discordant diagnosis.


RESULTS
The prevalence of concordant diagnoses was 97.6 percent (1,205 of 1,234) (95 percent confidence interval, 96.6 to 98.4 percent), the prevalence of discrepant diagnoses was 2.3 percent (twenty-eight of 1,234) (95 percent confidence interval, 1.4 to 3.1 percent), and the prevalence of discordant diagnoses was 0.1 percent (one of 1,234) (95 percent confidence interval, 0.1 to 0.3 percent). The cost per discrepant diagnosis was $4,383, and the cost per discordant diagnosis was $122,728.


CONCLUSIONS
Routine pathological examination of surgical specimens from patients undergoing primary total hip or knee replacement because of the clinical diagnosis of osteoarthritis had limited cost-effectiveness at our hospital due to the low prevalence of findings that altered patient management.
Kocher
M S
MS
Department of Orthopaedic Surgery, Brigham and Women's Hospital, and the Harvard School of Public Health, Boston, Massachusetts 02115, USA. kocher_m@a1.tch.harvard.edu
Erens
G
G
Thornhill
T S
TS
Ready
J E
JE
D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000191:economics*; D019645:Arthroplasty, Replacement, Knee / Q000191:economics*; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003955:Diagnostic Tests, Routine / Q000191:economics*; D005260:Female; D006621:Hip Joint / Q000473:pathology*; D017722:Hospital Charges; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics; D007719:Knee Joint / Q000473:pathology*; D008297:Male; D006278:Medicare / Q000191:economics; D015207:Osteoarthritis, Hip / Q000473:pathology / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D014481:United States