Total Knee Arthroplasty Out-of-Pocket Costs on the Rise: A Nationwide Analysis of Financial Burden and Regional Disparities.

Abstract

Out-of-pocket costs (OOPCs) for arthroplasty procedures represent a growing financial burden for patients. There is limited available data on trends and the impact of geographical location. The purpose of this study was to analyze temporal trends and to assess differences in OOPCs by surgical setting, insurance plan type, and geography associated with total knee arthroplasty (TKA) in the United States (U.S). A retrospective analysis of patients who underwent TKA from 2015 to 2020 was conducted using a large national database. Patients were identified using Current Procedural Terminology codes, and OOPCs were calculated as the sum of deductibles, copayments, and coinsurance. All financial data was adjusted to 2020 U.S. dollar equivalents. The OOPCs were analyzed over time and by geographic location, along with the impact of insurance type and surgical setting on OOPCs. In total, 34,942 patients who underwent TKA were identified for analysis. The OOPCs significantly increased from 2015 to 2020 (P < 0.05), with a mean OOPC of $2,472 + 1,990. The TKA OOPCs varied significantly by geography, with the highest costs in Alaska ($3,910) and the lowest costs in Hawaii ($1,024) (P < 0.001). Regionally, the West had the highest OOPCs ($2,562), while the Northeast had the lowest ($2,035) (P < 0.001). Ambulatory surgical centers incurred higher OOPCs than outpatient hospital settings for all procedures (P < 0.01). High-deductible health plans had the highest, and point-of-service with capitation health plans had the lowest OOPCs among all insurance types. The OOPCs for TKA procedures have significantly increased over time. With geography, surgical setting, and insurance type significantly affecting OOPCs, understanding how these factors impact costs will allow physicians and policymakers to improve resource allocation and develop cost-saving strategies to minimize patient financial burdens associated with arthroplasty procedures.