Evidence of Pent-Up Demand for Total Hip and Total Knee Arthroplasty at Age 65

Adam J. Schwartz, Yu Hui H. Chang, Kevin Bozic, David A. Etzioni

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Despite efforts to curtail the economic burden of total joint arthroplasty (TJA), utilization of these successful procedures continues to increase. Previous studies have provided evidence for pent-up demand (delaying necessary medical care until financially feasible) in health care as insurance status changes. We sought to determine whether evidence exists for pent-up demand in the TJA population when patients become eligible for Medicare enrollment. Methods: The 2014 Nationwide Readmission Database was used to determine the incidence of TJA. The observed increase in incidence from age 64 to 65 was compared to the expected increase. Pent-up demand was calculated by subtracting the expected from the observed difference in frequency of TJA, and excess cost was determined by multiplying this value by the median cost of a primary TJA. The Medicare Expenditure Panel Survey Household Component was used to compare out-of-pocket (OOP) costs, access to care, and insurance coverage among patients aged 60-64 (group 1) and 66-70 (group 2). Results: The expected and observed increases in TJA procedures from age 64 to 65 were 595 and 5211, respectively, resulting in pent-up demand of 4616 joint arthroplasties (1273 THA and 3343 TKA), and an excess cost of $55 million (range, $33 million-$70 million). Mean total OOP expenses for patients in group 1 were significantly greater ($1578.39) than patients in group 2 ($1143.63, P <.001). Despite spending more money OOP, the proportion of patients who were unable to obtain necessary medical care was significantly higher in group 1 than group 2 (4.9% vs 2.4%, P <.0001). This discrepancy was most prominent among patients with public insurance (10.6% vs 2.5%, P <.0001). Conclusion: The findings of this study suggest that patients with hip and knee osteoarthritis likely delay elective TJA until they are eligible for Medicare enrollment, resulting in significant additional financial burden to the public health system. As the population ages, it will become increasingly important for stakeholders and policy-makers to be aware of this pent-up demand for TJA procedures. Level of Evidence: Therapeutic level IV.

Original languageEnglish (US)
Pages (from-to)194-200
Number of pages7
JournalJournal of Arthroplasty
Volume34
Issue number2
DOIs
StatePublished - Feb 1 2019

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Knee Replacement Arthroplasties
Arthroplasty
Hip
Joints
Health Expenditures
Medicare
Insurance Coverage
Costs and Cost Analysis
Tacrine
Hip Osteoarthritis
Knee Osteoarthritis
Incidence
Insurance
Administrative Personnel
Population
Public Health
Economics
Databases
Delivery of Health Care

Keywords

  • Medicare Expenditure Panel Survey
  • Nationwide Readmission Database
  • medicare
  • pent-up demand
  • total joint arthroplasty
  • value-based health care

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Evidence of Pent-Up Demand for Total Hip and Total Knee Arthroplasty at Age 65. / Schwartz, Adam J.; Chang, Yu Hui H.; Bozic, Kevin; Etzioni, David A.

In: Journal of Arthroplasty, Vol. 34, No. 2, 01.02.2019, p. 194-200.

Research output: Contribution to journalArticle

Schwartz, Adam J. ; Chang, Yu Hui H. ; Bozic, Kevin ; Etzioni, David A. / Evidence of Pent-Up Demand for Total Hip and Total Knee Arthroplasty at Age 65. In: Journal of Arthroplasty. 2019 ; Vol. 34, No. 2. pp. 194-200.
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AU - Etzioni, David A.

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N2 - Background: Despite efforts to curtail the economic burden of total joint arthroplasty (TJA), utilization of these successful procedures continues to increase. Previous studies have provided evidence for pent-up demand (delaying necessary medical care until financially feasible) in health care as insurance status changes. We sought to determine whether evidence exists for pent-up demand in the TJA population when patients become eligible for Medicare enrollment. Methods: The 2014 Nationwide Readmission Database was used to determine the incidence of TJA. The observed increase in incidence from age 64 to 65 was compared to the expected increase. Pent-up demand was calculated by subtracting the expected from the observed difference in frequency of TJA, and excess cost was determined by multiplying this value by the median cost of a primary TJA. The Medicare Expenditure Panel Survey Household Component was used to compare out-of-pocket (OOP) costs, access to care, and insurance coverage among patients aged 60-64 (group 1) and 66-70 (group 2). Results: The expected and observed increases in TJA procedures from age 64 to 65 were 595 and 5211, respectively, resulting in pent-up demand of 4616 joint arthroplasties (1273 THA and 3343 TKA), and an excess cost of $55 million (range, $33 million-$70 million). Mean total OOP expenses for patients in group 1 were significantly greater ($1578.39) than patients in group 2 ($1143.63, P <.001). Despite spending more money OOP, the proportion of patients who were unable to obtain necessary medical care was significantly higher in group 1 than group 2 (4.9% vs 2.4%, P <.0001). This discrepancy was most prominent among patients with public insurance (10.6% vs 2.5%, P <.0001). Conclusion: The findings of this study suggest that patients with hip and knee osteoarthritis likely delay elective TJA until they are eligible for Medicare enrollment, resulting in significant additional financial burden to the public health system. As the population ages, it will become increasingly important for stakeholders and policy-makers to be aware of this pent-up demand for TJA procedures. Level of Evidence: Therapeutic level IV.

AB - Background: Despite efforts to curtail the economic burden of total joint arthroplasty (TJA), utilization of these successful procedures continues to increase. Previous studies have provided evidence for pent-up demand (delaying necessary medical care until financially feasible) in health care as insurance status changes. We sought to determine whether evidence exists for pent-up demand in the TJA population when patients become eligible for Medicare enrollment. Methods: The 2014 Nationwide Readmission Database was used to determine the incidence of TJA. The observed increase in incidence from age 64 to 65 was compared to the expected increase. Pent-up demand was calculated by subtracting the expected from the observed difference in frequency of TJA, and excess cost was determined by multiplying this value by the median cost of a primary TJA. The Medicare Expenditure Panel Survey Household Component was used to compare out-of-pocket (OOP) costs, access to care, and insurance coverage among patients aged 60-64 (group 1) and 66-70 (group 2). Results: The expected and observed increases in TJA procedures from age 64 to 65 were 595 and 5211, respectively, resulting in pent-up demand of 4616 joint arthroplasties (1273 THA and 3343 TKA), and an excess cost of $55 million (range, $33 million-$70 million). Mean total OOP expenses for patients in group 1 were significantly greater ($1578.39) than patients in group 2 ($1143.63, P <.001). Despite spending more money OOP, the proportion of patients who were unable to obtain necessary medical care was significantly higher in group 1 than group 2 (4.9% vs 2.4%, P <.0001). This discrepancy was most prominent among patients with public insurance (10.6% vs 2.5%, P <.0001). Conclusion: The findings of this study suggest that patients with hip and knee osteoarthritis likely delay elective TJA until they are eligible for Medicare enrollment, resulting in significant additional financial burden to the public health system. As the population ages, it will become increasingly important for stakeholders and policy-makers to be aware of this pent-up demand for TJA procedures. Level of Evidence: Therapeutic level IV.

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