In hospital cost assessment and prevalence of Total Hip Arthroplasty in China: A 10-years real-world study

Abstract Background: The rising costs of total hip arthroplasty (THA) have resulted in a substantial economic burden to the people of China and Chinese health-care system. The objective of this study was to assess the in-hospital costs associated with primary total hip arthroplasty and efforts to contain these costs by ascertaining factors responsible for the rise in cost.Methods: In-hospital costs of 8111 patients (3878 male and 42337female) who underwent elective primary unilateral hip arthroplasty were extracted from our institution between January 2009 and December 2018 and reviewed. The number of yearly procedures was recorded. All hospital related charges were categorized into 9 groups based on hospital-based supplies and services. The correlation between total in hospital cost and 9 groups were assessed using Pearson’s coefficient. The same method was used for correlating hospital stay and bed charge.Results: The substantial rise in yearly procedure volume was observed. The number of procedures had risen from 306 in 2009 to 1024 in 2018, an incidence increased by more than threefold. The average cost for THAs procedure was ¥53468.03 ± 4833 in 2009 that rose by approximately 10% in 2018 (¥58593.62 ± 4801). The mean cost observed over the study period was ¥62980.21 ± 6314.673. The charges analyzed in all categories expect the hospital bed cost increased during the study period. The joint implant was the most expensive supply item contributing ~ 75% of the total in-hospital cost. Labor cost covered only ~ 10% and bed charge 0.93% of the total charge. The rise in total in-hospital cost strongly correlated with increase in implant cost (Pearson’s correlation (r) = 0.908, α > 0.05). The mean total hospital stays declined from 16.11 ± 8.19 days in 2009 to 6.13 ± 2.65 days in 2018. The mean post-operative stay had also reduced from 9.12 ± 4.88 to a third (3.01 ± 1.80) during the same period. The hospital cost and bed charge also strongly correlated (r = 0.931, α > 0.05)Conclusions: The number of hip arthroplasty procedures performed annually in China is growing rapidly. An incidence rose by threefold over 10-year period in the present study and we predict an unprecedented rise in the incidence in coming years due to an aging population and improving economic conditions in China. The hospital stay was significantly reduced and early discharge within 3 days postoperatively was a noteworthy outcome. Implant cost remained the largest single expense. As a result, some patients who are medical candidates for total joint arthroplasty, may not have access to care due to relatively high financial barrier. Hence it is important to note that significant patient benefits may be realized by efforts to reduce the cost of the prosthesis in China.