Elsevier

The Journal of Arthroplasty

Volume 36, Issue 5, May 2021, Pages 1484-1489.e3
The Journal of Arthroplasty

Health Policy & Economics
Projected Economic Burden of Periprosthetic Joint Infection of the Hip and Knee in the United States

https://doi.org/10.1016/j.arth.2020.12.005Get rights and content

Abstract

Background

In addition to the significant morbidity and mortality associated with periprosthetic joint infection (PJI), the cost of treating PJI is substantial. Prior high-quality national estimates of the economic burden of PJI utilize data up to 2009 to project PJI growth in the United States through 2020. Now in the year 2020, it is appropriate to evaluate these past projections and incorporate the latest available data to better understand the current scale and burden of PJI in the United States.

Methods

The Nationwide Inpatient Sample (2002-2017) was used to identify rates and associated inpatient costs for primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) and PJI-related revision TKA and THA. Poisson regression was utilized to model past growth and project future rates and cost of PJI of the hip and knee.

Results

Using the most recent data, the combined annual hospital costs related to PJI of the hip and knee were estimated to be $1.85 billion by 2030. This includes $753.4 million for THA PJI and $1.1 billion for TKA PJI, in that year. Increases in PJI costs are mainly attributable to increases in volume. Although the growth in incidence of primary THA and TKA has slowed in recent years, the incidence of PJI and the cost per case of PJI remained relatively constant from 2002 to 2017.

Discussion

Understanding the current and potential future financial burden of PJI for surgeons, patients, and healthcare systems is essential. There is an urgent need for efficacious preventive strategies in reducing rates of PJI after THA and TKA.

Section snippets

Methods

We used the Nationwide Inpatient Sample (NIS) to determine the number of primary and revision knee and hip arthroplasties performed between January 1, 2002 and December 31, 2017. The NIS is a publicly available all-payer database containing data on over 7 million hospital visits. The database is designed for the calculation of both national and regional estimates of clinical diagnoses and inpatient procedures [11]. The NIS was created with the intention to inform healthcare policy.

Within the

Results

The annual number of infected THAs increased from 5075 in 2002 to 8635 in 2012 (Table 1, Fig. 1). Over the next 5-year period, the annual number of infected THAs increased to 11,985 in 2017. In 2002, the number of infected TKAs was 8,205, increasing to 17,055 in 2012. By 2017, the estimated annual number of infected TKAs increased to 28,161.

Although average cost per case of THA or TKA PJI remained relatively stable over the period from 2002 to 2017, total costs nationally increased drastically

Discussion

PJI of the hip and knee remains a significant burden to the US healthcare system. Utilizing the most recent high-quality national data, we have projected PJI growth and its associated economic burden through 2030. The combined estimated annual hospital costs of PJI for the hip and knee were estimated to be $1.85 billion by 2030. This estimate includes $753.4 million for THA PJI and $1.1 billion for TKA PJI, in that year.

Prior estimates of the cost of PJI in the United States were generally

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    Ajay Premkumar and David A. Kolin contributed equally to this manuscript.

    One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2020.12.005.

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