ClinicoEconomics and Outcomes Research (Aug 2024)

Health Technology Assessment for Fast-Track Elective Knee and Hip Arthroplasty in a High-Volume Orthopaedic Hospital in Italy

  • Restelli U,
  • Vitale J,
  • Croce E,
  • Bernareggi S,
  • Guida S,
  • Silvola S,
  • Banfi G,
  • Zagra L

Journal volume & issue
Vol. Volume 16
pp. 537 – 545

Abstract

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Umberto Restelli,1 Jacopo Vitale,2 Edoardo Croce,3 Susan Bernareggi,3 Stefania Guida,3 Sofia Silvola,1,4 Giuseppe Banfi,3,5 Luigi Zagra3 1LIUC University, Castellanza, Italy; 2Schulthess Klinik, Zürich, Switzerland; 3IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; 4Department of Public Health Medicine, School of Health System & Public Health, Faculty of Health Science, University of Pretoria, Pretoria, South Africa; 5Vita-Salute San Raffaele University, Milan, ItalyCorrespondence: Umberto Restelli, Email [email protected]: The objective of the analysis presented is to assess the efficacy of a fast-track pathway for elective hip and knee arthroplasty, compared to the traditional approach, adopted within a research hospital located in Milan (Italy), in terms of length of stay reduction and related direct medical costs.Methods: A monocentric observational retrospective study was implemented considering adult subjects who underwent elective primary total hip or knee replacement, with a diagnosis of primary or secondary osteoarthritis. Exclusion criteria were subjects admitted via emergency department, subjects undergoing knee or hip replacement because of fractures or prosthesis revision. The analysis compared the length of stay and the direct medical costs, assuming the hospital perspective, of subjects admitted in the pre-fast-track period (years 2016/2017) and during the fast-track period (years 2018/2019).Results: Knee replacement mean costs are 5,599 € (± 1,158.3 €) in the pre-fast-track period and 4,487 € (± 978.4 €) in the fast-track period (− 1,112 €; − 19.9%). Hip replacement mean costs in the pre-fast-track period are 5,364 € (± 1,037.2 €) and 4,450 € (± 843.7 €) in the fast-track period (− 914 €; − 17.0%). The adoption of fast-track pathway led to a statistically significant decrease of days of hospitalization of − 2.8 (− 37.6%) in knee replacement and of − 2.9 (− 39.2%) in hip replacement.Conclusion: The fast-track pathway adopted proved to be effective, reducing patients’ length of stay, and sustainable and efficient, reducing direct medical costs, for both elective hip and knee replacement surgeries.Keywords: health economics, direct medical costs, observational, hip replacement, knee replacement

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