Cost analysis in total hip arthroplasty: experience of a teaching medical center located in Paris

Background: Since the beginning of 2008, the implementation of a 100% activity-based payment system, has made efficiency one of the prime concern for the French health-care providing institutions. We therefore assessed the real cost of a scheduled total hip replacement (THR) ina teaching hospital and compared findings with French national data (and with the Government Healthcare Insurance System allowance).

Hypothesis: The study should suggest possible means to optimize organization of management and/or clinicians' practice.

Material and methods: This is a retrospective full-cost economic study. Patients were included only if fulfilling the following criteria: admitted in 2006; classified in Diagnosis-Related Group (DRG) 08C23 V or 08C23W (respectively THR without and with associated comorbidity); treated in a single department; admitted from home; and having undergone a THR (coded as NEKA020 in the french CPT) that same year. Treatment-cost was established on the basis of data collected from two main sources: the Information Systems Medicalization Program (ISMP) data-base, and the finance department data, which were taken into account in line with the French National Costs Study (NCS) structure.

Results: The methodology employed here follows the 2006 National Costs Scale structure. Treatment costs (excluding the cost of implantable medical devices or IMDs) were estimated at 8,104.72 EUR for DRG 08C23W and 7,529.19 EUR for DRG 08C23 V. These figures were higher than the rates authorized in 2006 (excluding IMDs), which were 7,677.92 EUR for 08C23W and 6,358.97 EUR for 08C23 V (taking the 7% geographic coefficient into account) and than the 2005 NCS figures (excluding IMDs) of respectively 7,536.13 EUR and 6,083.59 EUR.

Discussion: Clinical units and departments need to be able to assess costs for the pathologies they treat, as health-care institutions have to balance their expenditure against their income, which largely comes from their hospital-care activity. The methodology put forward here, of cost comparison according to the NCS structure, enables the total cost to be known. Comparing results (expenditure line by expenditure line) against national data, selectively highlights the areas in which efficiency can be improved. The exactitude of the obtained results remains, however, limited by the rules currently in use at each individual hospital's accounting department.

Level of evidence: Level IV, retrospective economic and decision analysis study.