title: Orthopaedic surgeons frequently underestimate the cost of orthopaedic implants.
abstract: BACKGROUND
  A poor understanding of cost among healthcare providers may contribute to high healthcare expenditures. Currently, it is unclear whether and how much surgeons know about the costs of implantable medical devices (IMDs).
  
  
  OBJECTIVE
  We (1) determined the level of comfort with orthopaedic IMD costs among orthopaedic residents and attending surgeons, (2) quantified how accurately surgeons understand the costs of orthopaedic IMDs, and (3) identified which constructs yield the most accurate cost estimations among residents and attending surgeons.
  
  
  METHODS
  A questionnaire was presented to 60 residents and 37 attending orthopaedic surgeons from two large academic medical centers. Respondents estimated the cost of 13 commonly used orthopaedic devices. Fifty-one surgeons participated (36 residents, 15 attending surgeons), for an overall response rate of 53%. Cost estimates were compared against the actual material costs, and we recorded the percentage error for each estimate.
  
  
  RESULTS
  More than ½ of the respondents rated their knowledge of IMD cost as poor. The mean percentage error in estimation for all respondents was 69% (range, 29%-289%). Overall, 67% of responses were underestimations and 33% were overestimations. Residents demonstrated a mean percentage error of 73% (range, 29%-289%) while attending surgeons had a mean percentage error of 59% (range, 49%-79%). Residents and attending surgeons demonstrated differences in accuracy within groups and between groups based on the IMD being estimated.
  
  
  CONCLUSIONS
  We found the knowledge of orthopaedic IMD costs among the orthopaedic residents and attending surgeons surveyed was poor. Further investigation of how physicians conceptualize material costs will be important to healthcare cost control.
authors.affiliation: Department of Orthopaedic Surgery, Case Western Reserve University-University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA. jonathanstreit@gmail.com
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Streit
authors.forename: Ashraf
authors.initials: A
authors.lastname: Youssef
authors.forename: Robert M
authors.initials: RM
authors.lastname: Coale
authors.forename: James E
authors.initials: JE
authors.lastname: Carpenter
authors.forename: Randall E
authors.initials: RE
authors.lastname: Marcus
mesh_terms: D000046:Academic Medical Centers; D017048:Health Care Costs; D006801:Humans; D007396:Internship and Residency; D008505:Medical Staff, Hospital; D009985:Orthopedics / Q000191:economics*; D010818:Practice Patterns, Physicians' / Q000191:economics*; D019736:Prostheses and Implants / Q000191:economics*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires