title: Measuring the value of total hip and knee arthroplasty: considering costs over the continuum of care.
abstract: BACKGROUND
  Controlling escalating costs of hip (THA) and knee arthroplasty (TKA) without compromising quality of care has created the need for innovative system reorganization to inform sustainable solutions.
  
  
  OBJECTIVE
  The purpose of this study was to inform estimates of the value of THA and TKA by determining: (1) the data sources data required to obtain costs across the care continuum; (2) the data required for different analytical perspectives; and (3) the relative costs across the continuum of care.
  
  
  METHODS
  Within the context of a pragmatic randomized controlled trial comparing alternative care pathways, we captured healthcare resource use: (1) 12 months before surgery; (2) inpatient; (3) acute recovery; and (4) long-term recovery 3 and 12 months postsurgery. We established a standardized costing model to reflect both the healthcare payer and patient perspectives.
  
  
  RESULTS
  Multiple data sources from regional health authorities, administrative databases, and patient questionnaire were required to estimate costs across the care continuum. Inpatient and acute care costs were approximately 60% of the total with the remaining 40% incurred 12 months presurgery and 12 months postsurgery. Regional health authorities bear close to 60%, and patient costs are approximately 30% of the mean total costs, most of which were incurred after the acute inpatient stay.
  
  
  CONCLUSIONS
  To fully understand the value of an orthopaedic intervention such as THA and TKA, a broader perspective than one limited to the payer should be considered using a standardized measurement framework over a relevant time horizon and from multiple viewpoints to reflect the substantial patient burden and support sustainable improvement over the care continuum.
  
  
  METHODS
  Level III, economic and decision analyses study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: University of Calgary, Suite 400, 3280 Hospital Drive NW, Calgary, AB, Canada T2N 4Z6.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Marshall
authors.forename: Tracy
authors.initials: T
authors.lastname: Wasylak
authors.forename: Hoa
authors.initials: H
authors.lastname: Khong
authors.forename: Robyn D
authors.initials: RD
authors.lastname: Parker
authors.forename: Peter D
authors.initials: PD
authors.lastname: Faris
authors.forename: Cy
authors.initials: C
authors.lastname: Frank
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000191:economics*; D019645:Arthroplasty, Replacement, Knee / Q000191:economics*; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans