title: Surgeon-Directed Cost Variation in Isolated Rotator Cuff Repair.
abstract: BACKGROUND
  As value becomes a larger component of heath care decision making, cost data can be evaluated for regional and physician variation. Value is determined by outcome divided by cost, and reducing cost increases value for patients. "Third-party spend" items are individual selections by surgeons used to perform procedures. Cost data for third-party spend items provide surgeons and hospitals with important information regarding care value, potential cost-saving opportunities, and the total cost of ownership of specific clinical decisions.
  
  
  OBJECTIVE
  To perform a cost review of isolated rotator cuff repair within a regional 7-hospital system and to document procedure cost variation among operating surgeons.
  
  
  METHODS
  Economic and decision analysis; Level of evidence, 4.
  
  
  METHODS
  Current Procedural Terminology (CPT) codes were used to retrospectively identify subjects who received an isolated rotator cuff repair within a 7-hospital system. Cost data were collected for clinically sensitive third-party spend items and divided into 4 cost groups: (1) suture anchors, (2) suture-passing devices and needles, (3) sutures used for cuff repair, and (4) disposable tools or instruments.
  
  
  RESULTS
  A total of 62 isolated rotator cuff repairs were performed by 17 surgeons over a 13-month period. The total cost per case for clinically sensitive third-party spend items (in 2015 US dollars) ranged from $293 to $3752 (mean, $1826). Four surgeons had a mean procedure cost that was higher than the data set mean procedure cost. The cost of an individual suture anchor ranged from $75 to $1775 (mean, $403). One disposable suture passer was used, which cost $140. The cost of passing needles ranged from $140 to $995 (mean, $468). The cost per repair suture (used to repair cuff tears) varied from $18 to $298 (mean, $61). The mean suture (used to close wounds) cost per case was $81 (range, $0-$454). A total of 316 tools or disposable instruments were used, costing $1 to $1573 per case (mean, $624).
  
  
  CONCLUSIONS
  This study demonstrates significant cost variation with respect to cost per case and cost of individual items used during isolated rotator cuff repair. Suture anchors represent the most expensive and variable surgeon-directed cost. The wide cost variation seen in all cost categories illustrates both the effect of surgeon choice in procedure cost and the opportunity for significant cost savings in cases of isolated rotator cuff repair. Engaging surgeons in discussion on cost can positively influence the value of care provided to patients if costs can be reduced without affecting the quality of patient outcomes.
authors.affiliation: Georgetown School of Medicine, Washington, DC, USA.
authors.forename: E Bailey
authors.initials: EB
authors.lastname: Terhune
authors.affiliation: St Luke's Orthopaedics, Boise, Idaho, USA.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Cannamela
authors.affiliation: St Luke's Orthopaedics, Boise, Idaho, USA.
authors.forename: Jared S
authors.initials: JS
authors.lastname: Johnson
authors.affiliation: St Luke's Orthopaedics, Boise, Idaho, USA.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Saad
authors.affiliation: St Luke's Orthopaedics, Boise, Idaho, USA.
authors.forename: John
authors.initials: J
authors.lastname: Barnes
authors.affiliation: St Luke's Orthopaedics, Boise, Idaho, USA.
authors.forename: Janette
authors.initials: J
authors.lastname: Silbernagel
authors.affiliation: St Luke's Orthopaedics, Boise, Idaho, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Faciszewski
authors.affiliation: St Luke's Orthopaedics, Boise, Idaho, USA.
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Shea
keywords: economic and decision analysis; rotator cuff repair; value improvement