title: Time-driven Activity-based Cost of Fast-Track Total Hip and Knee Arthroplasty.
abstract: Fast-track total hip and knee arthroplasty (THA and TKA) has been shown to reduce the perioperative convalescence resulting in less postoperative morbidity, earlier fulfillment of functional milestones, and shorter hospital stay. As organizational optimization is also part of the fast-track methodology, the result could be a more cost-effective pathway altogether. As THA and TKA are potentially costly procedures and the numbers are increasing in an economical limited environment, the aim of this study is to present baseline detailed economical calculations of fast-track THA and TKA and compare this between 2 departments with different logistical set-ups.
  
  
  
  Prospective data collection was analyzed using the time-driven activity-based costing method (TDABC) on time consumed by different staff members involved in patient treatment in the perioperative period of fast-track THA and TKA in 2 Danish orthopedic departments with standardized fast-track settings, but different logistical set-ups.
  
  
  
  Length of stay was median 2 days in both departments. TDABC revealed minor differences in the perioperative settings between departments, but the total cost excluding the prosthesis was similar at USD 2511 and USD 2551, respectively.
  
  
  
  Fast-track THA and TKA results in similar cost despite differences in the organizational set-up. Compared to cost associated with longer more conventional published pathways, fast-track is cheaper, which on top of the favorable published clinical outcome adds to cost efficiency and the potential for economic savings. Detailed baseline TDABC calculations are provided for comparison and further optimization of cost-benefit effectiveness.
authors.affiliation: Orthopedic Department, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark.
authors.forename: Signe E
authors.initials: SE
authors.lastname: Andreasen
authors.affiliation: Orthopedic Department, Vejle Hospital, Vejle, Denmark.
authors.forename: Henriette B
authors.initials: HB
authors.lastname: Holm
authors.affiliation: Orthopedic Department, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark.
authors.forename: Mira
authors.initials: M
authors.lastname: Jørgensen
authors.affiliation: Orthopedic Department, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark.
authors.forename: Kirill
authors.initials: K
authors.lastname: Gromov
authors.affiliation: Orthopedic Department, Vejle Hospital, Vejle, Denmark.
authors.forename: Per
authors.initials: P
authors.lastname: Kjærsgaard-Andersen
authors.affiliation: Orthopedic Department, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Husted
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000191:economics*; D019645:Arthroplasty, Replacement, Knee / Q000191:economics*; D003362:Cost-Benefit Analysis; D004434:Early Ambulation / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D009017:Morbidity; D011446:Prospective Studies
keywords: economy; fast-track; hip arthroplasty; knee arthroplasty; time-driven activity-based cost