What Is the Long-Term Impact of an Implant Stewardship Program on Orthopaedic Trauma Implant Pricing?

Abstract

To analyze the effectiveness of an implant stewardship program on implant cost containment and to estimate surgeons' responsiveness to implant price changes. Interrupted time series. Level I trauma center. Monitored usage of 5 trauma constructs by 10 surgeons over a 5-year period. Red-Yellow-Green (RYG) implant pricing comparison chart. Primary outcomes were changes in the mean price, minimum price, and the number of price changes. The secondary outcome was surgeons' responsiveness to RYG/cost changes. The study consisted of 2468 procedures. A mean construct price decrease of $66 per year [95% confidence interval (CI), $-170 to $-151], with distal femoral plates demonstrating the largest mean annual price decline ($486; 95% CI, $-540 to $-432). The minimum construct price decreased by $131 per year (95% CI, $-155 to $-111), with the largest reductions observed for distal femoral plates (-$436 per year; 95% CI, $-516 to $-354) and external fixators (-$122 per year; 95% CI, $-258 to $-136). The median price decrease was $407 (range: $6 to $2491) or 12.5% of the previous price. Positive changes in RYG levels increased surgeons' usage of tibial nails by 115%, femoral nails by 106%, and external fixators by 104%. Surgeons' implant selection was insensitive to RYG changes for distal femoral plates [RYG elasticity (ERYG): -0.74] and proximal tibia plates (ERYG: -0.21). The implant stewardship program was associated with substantial implant price reductions. Surgeons' implant selection was especially sensitive to price changes for intramedullary nails and external fixators.