Abstract：
BACKGROUND: Using time-driven activity-based costing (TDABC), a novel cost calculation method that more accurately reflects true resource utilization in health care, we sought to compare the total facility costs across different body mass index (BMI) groups following total joint arthroplasty (TJA).
METHODS: The study consisted of 13,806 TJAs (7,340 total knee arthroplasties [TKAs] and 6,466 total hip arthroplasties [THAs]) performed between 2019 and 2023. The TDABC data from an analytics platform was employed to depict total facility costs, comprising personnel and supply costs. For the analysis, patients were stratified into four BMI categories: <30, 30 to <35, 35 to <40, and ≥40. Multivariable regression was used to determine the independent effect of BMI on facility costs.
RESULTS: When indexed to patients who had BMI <30, elevated BMI categories (30 to <35, 35 to <40, and ≥40) were associated with higher total personnel costs (TKA 1.03x versus 1.07x versus 1.13x, P < .001; THA 1.00x versus 1.08x versus 1.08x, P < .001), and total supply costs (TKA 1.01x versus 1.04x versus 1.04x, P < .001; THA 1.01x versus 1.02x versus 1.03x, P = .007). Total facility costs in TJAs were significantly greater in higher BMI categories (TKA 1.02x versus 1.05x versus 1.08x, P < .001; THA 1.01x versus 1.05x versus 1.05x, P < .001). Notably, when incorporating adjustments for demographics and comorbidities, BMI values of 35, 40, and 45 relative to BMI of 25, exhibit a significant association with a 2, 3, and 5% increase in total facility cost for TKAs and a 3, 5, and 7% increase for THAs.
CONCLUSIONS: Using TDABC methodology, this study found that overall facility costs of TJAs increase with BMI. The present study provides patient-level cost insights, indicating the potential need for reassessment of physician compensation models in this population. Further studies may facilitate the development of risk-adjusted procedural codes and compensation models for public and private payors.
METHODS: Level IV, economic and decision analyses.
METHODS: The study consisted of 13,806 TJAs (7,340 total knee arthroplasties [TKAs] and 6,466 total hip arthroplasties [THAs]) performed between 2019 and 2023. The TDABC data from an analytics platform was employed to depict total facility costs, comprising personnel and supply costs. For the analysis, patients were stratified into four BMI categories: <30, 30 to <35, 35 to <40, and ≥40. Multivariable regression was used to determine the independent effect of BMI on facility costs.
RESULTS: When indexed to patients who had BMI <30, elevated BMI categories (30 to <35, 35 to <40, and ≥40) were associated with higher total personnel costs (TKA 1.03x versus 1.07x versus 1.13x, P < .001; THA 1.00x versus 1.08x versus 1.08x, P < .001), and total supply costs (TKA 1.01x versus 1.04x versus 1.04x, P < .001; THA 1.01x versus 1.02x versus 1.03x, P = .007). Total facility costs in TJAs were significantly greater in higher BMI categories (TKA 1.02x versus 1.05x versus 1.08x, P < .001; THA 1.01x versus 1.05x versus 1.05x, P < .001). Notably, when incorporating adjustments for demographics and comorbidities, BMI values of 35, 40, and 45 relative to BMI of 25, exhibit a significant association with a 2, 3, and 5% increase in total facility cost for TKAs and a 3, 5, and 7% increase for THAs.
CONCLUSIONS: Using TDABC methodology, this study found that overall facility costs of TJAs increase with BMI. The present study provides patient-level cost insights, indicating the potential need for reassessment of physician compensation models in this population. Further studies may facilitate the development of risk-adjusted procedural codes and compensation models for public and private payors.
METHODS: Level IV, economic and decision analyses.
摘要：
背景：使用时间驱动的基于活动的成本计算（TDABC），一种新颖的成本计算方法，可以更准确地反映医疗保健中的真实资源利用率，我们试图比较全关节置换术(TJA)后不同体重指数(BMI)组的设施总费用.
方法：该研究由2019年至2023年进行的13,806个TJAs（7,340个TKAs和6,466个TAs）组成。来自分析平台的TDABC数据用于描述总设施成本，包括人员和供应成本。为了分析，将患者分为4个BMI类别:<30,30~<35,35~<40和≥40.使用多变量回归来确定BMI对设施成本的独立影响。
结果：当针对BMI<30的患者进行索引时，升高的BMI类别（30至<35，35至<40和≥40）与较高的总人员成本相关（TKA1.03x对1.07x对1.13x，P<0.001；THA1.00x对1.08x对1.08x，P<0.001)，和总供应成本（TKA1.01倍对1.04倍对1.04倍，P<0.001；THA1.01x对1.02x对1.03x，P=0.007)。在BMI较高的类别中，TJAs的总设施成本明显更高（TKA1.02x对1.05x对1.08x，P<0.001；THA1.01x与1.05xvs.1.05x,P<0.001)。值得注意的是,当纳入人口统计和合并症的调整时，35、40和45的BMI值相对于25的BMI值表现出与TKA的总设施成本增加2、3和5％以及THA的3、5和7％增加的显着关联。
结论：使用TDABC方法，这项研究发现，TJAs的总体设施成本随着BMI的增加而增加。本研究提供了患者层面的成本见解，这表明在这一人群中可能需要重新评估医生补偿模型。进一步的研究可能有助于为公共和私人付款人制定风险调整的程序守则和补偿模型。
方法：该研究由2019年至2023年进行的13,806个TJAs（7,340个TKAs和6,466个TAs）组成。来自分析平台的TDABC数据用于描述总设施成本，包括人员和供应成本。为了分析，将患者分为4个BMI类别:<30,30~<35,35~<40和≥40.使用多变量回归来确定BMI对设施成本的独立影响。
结果：当针对BMI<30的患者进行索引时，升高的BMI类别（30至<35，35至<40和≥40）与较高的总人员成本相关（TKA1.03x对1.07x对1.13x，P<0.001；THA1.00x对1.08x对1.08x，P<0.001)，和总供应成本（TKA1.01倍对1.04倍对1.04倍，P<0.001；THA1.01x对1.02x对1.03x，P=0.007)。在BMI较高的类别中，TJAs的总设施成本明显更高（TKA1.02x对1.05x对1.08x，P<0.001；THA1.01x与1.05xvs.1.05x,P<0.001)。值得注意的是,当纳入人口统计和合并症的调整时，35、40和45的BMI值相对于25的BMI值表现出与TKA的总设施成本增加2、3和5％以及THA的3、5和7％增加的显着关联。
结论：使用TDABC方法，这项研究发现，TJAs的总体设施成本随着BMI的增加而增加。本研究提供了患者层面的成本见解，这表明在这一人群中可能需要重新评估医生补偿模型。进一步的研究可能有助于为公共和私人付款人制定风险调整的程序守则和补偿模型。
