What Patient, Surgical, and Hospital Factors Are Associated With Increased Value in Primary Total Hip Arthroplasty? A Patient-Level Value Analysis of 2,203 Procedures With Time-Driven Activity-Based Costing.

Background: In the context of value-based health care, combining patient-reported outcome measures (PROMs) with cost-effectiveness analyses is essential. Few studies link PROMs with time-driven activity-based costing (TDABC) for total hip arthroplasty (THA). This study analyzed patient-level variations and identified value drivers in primary THA using TDABC and Hip Osteoarthritis Outcome Score-Physical Function Shortform (HOOS-PS) scores to optimize value in arthroplasty.

Methods: A total of 2,203 primary manual THAs from 2016 to 2023 were retrospectively analyzed. Preoperative and postoperative HOOS-PS scores were collected, and THA costs of care were calculated using TDABC. Costs were converted from US dollars to cost units (CUs) by dividing costs by an undisclosed constant. Value was defined as the change from preoperative to 1-year postoperative HOOS-PS score relative to the THA cost of care. Value was converted to a scale with a maximum of 100. Multivariable linear regressions determined factors contributing to variations in Value and costs of care.

Results: Increased THA Value was independently associated with outpatient surgery (adjusted mean difference (AMD): +5.9; P < 0.001), home discharge (AMD: +5.3; P < 0.001), and lower preoperative HOOS-PS score (AMD per 1-unit decrease: +0.7; P < 0.001). Factors associated with increased costs of care included cemented implant use (AMD: +125 CUs; P < 0.001), anterior or lateral surgical approach (AMD: +55 CUs; P < 0.001), non-White race/ethnicity (AMD: +35 CUs; P = 0.046), depression (AMD: +22 CUs; P = 0.023), higher Charlson Comorbidity Index (AMD per 1-unit: +12 CUs; P = 0.005), and higher body mass index (AMD per 1 kg/m2: +2.2 CUs; P = 0.045).

Conclusions: Using TDABC and PROMs, this study highlighted substantial variation in THA value and identified value drivers. Integrating these insights can guide strategies to improve clinical outcomes and optimize resource allocation to optimize value in THA.