The Effect of Price on Surgeons’ Choice of Implants: A Randomized Controlled Survey

and the, Science of Variation Group

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Purpose Surgical costs are under scrutiny and surgeons are being held increasingly responsible for cost containment. In some instances, implants are the largest component of total procedure cost, yet previous studies reveal that surgeons’ knowledge of implant prices is poor. Our study aims to (1) understand drivers behind implant selection and (2) assess whether educating surgeons about implant costs affects implant selection. Methods We surveyed 226 orthopedic surgeons across 6 continents. The survey presented 8 clinical cases of upper extremity fractures with history, radiographs, and implant options. Surgeons were randomized to receive either a version with each implant's average selling price (“price-aware” group), or a version without prices (“price-naïve” group). Surgeons selected a surgical implant and ranked factors affecting implant choice. Descriptive statistics and univariate, multivariable, and subgroup analyses were performed. Results For cases offering implants within the same class (eg, volar locking plates), price-awareness reduced implant cost by 9% to 11%. When offered different models of distal radius volar locking plates, 25% of price-naïve surgeons selected the most expensive plate compared with only 7% of price-aware surgeons. For cases offering different classes of implants (eg, plate vs external fixator), there was no difference in implant choice between price-aware and price-naïve surgeons. Familiarity with the implant was the most common reason for choosing an implant in both groups (35% vs 46%). Price-aware surgeons were more likely to rank cost as a factor (29% vs 21%). Conclusions Price awareness significantly influences surgeons’ choice of a specific model within the same implant class. Merely including prices with a list of implants leads surgeons to select less expensive implants. This implies that an untapped opportunity exists to reduce surgical expenditures simply by enhancing surgeons’ cost awareness. Type of study/level of evidence Economic/Decision Analyses I.

Original languageEnglish (US)
Pages (from-to)593-601.e6
JournalJournal of Hand Surgery
Volume42
Issue number8
DOIs
StatePublished - Aug 1 2017

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Costs and Cost Analysis
Surveys and Questionnaires
Surgeons
External Fixators
Decision Support Techniques
Cost Control
Health Expenditures
Upper Extremity
History
Economics

Keywords

  • Cost
  • implant
  • price
  • surgeon
  • survey

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

The Effect of Price on Surgeons’ Choice of Implants : A Randomized Controlled Survey. / and the; Science of Variation Group.

In: Journal of Hand Surgery, Vol. 42, No. 8, 01.08.2017, p. 593-601.e6.

Research output: Contribution to journalArticle

and the ; Science of Variation Group. / The Effect of Price on Surgeons’ Choice of Implants : A Randomized Controlled Survey. In: Journal of Hand Surgery. 2017 ; Vol. 42, No. 8. pp. 593-601.e6.
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abstract = "Purpose Surgical costs are under scrutiny and surgeons are being held increasingly responsible for cost containment. In some instances, implants are the largest component of total procedure cost, yet previous studies reveal that surgeons’ knowledge of implant prices is poor. Our study aims to (1) understand drivers behind implant selection and (2) assess whether educating surgeons about implant costs affects implant selection. Methods We surveyed 226 orthopedic surgeons across 6 continents. The survey presented 8 clinical cases of upper extremity fractures with history, radiographs, and implant options. Surgeons were randomized to receive either a version with each implant's average selling price (“price-aware” group), or a version without prices (“price-na{\"i}ve” group). Surgeons selected a surgical implant and ranked factors affecting implant choice. Descriptive statistics and univariate, multivariable, and subgroup analyses were performed. Results For cases offering implants within the same class (eg, volar locking plates), price-awareness reduced implant cost by 9{\%} to 11{\%}. When offered different models of distal radius volar locking plates, 25{\%} of price-na{\"i}ve surgeons selected the most expensive plate compared with only 7{\%} of price-aware surgeons. For cases offering different classes of implants (eg, plate vs external fixator), there was no difference in implant choice between price-aware and price-na{\"i}ve surgeons. Familiarity with the implant was the most common reason for choosing an implant in both groups (35{\%} vs 46{\%}). Price-aware surgeons were more likely to rank cost as a factor (29{\%} vs 21{\%}). Conclusions Price awareness significantly influences surgeons’ choice of a specific model within the same implant class. Merely including prices with a list of implants leads surgeons to select less expensive implants. This implies that an untapped opportunity exists to reduce surgical expenditures simply by enhancing surgeons’ cost awareness. Type of study/level of evidence Economic/Decision Analyses I.",
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T1 - The Effect of Price on Surgeons’ Choice of Implants

T2 - A Randomized Controlled Survey

AU - and the

AU - Science of Variation Group

AU - Wasterlain, Amy S.

AU - Melamed, Eitan

AU - Karia, Raj

AU - Capo, John T.

AU - Bello, Ricardo

AU - Adams, Julie

AU - Vochteloo, A. J.H.

AU - Powell, Andrew John

AU - Marcus, Alexander

AU - Andreas, Platz

AU - Miller, Anna N.

AU - Berner, A. B.Arne

AU - Altintas, Burak

AU - Sears, Benjamin W.

AU - Calfee, Ryan P.

AU - Ekholm, Carl

AU - Fernandes, C. H.

AU - Porcellini, Giuseppe

AU - Jones, Clifford

AU - Moreno-Serrano, Constanza L.

AU - Manke, Chad

AU - Crist, Brett D.

AU - Haverkamp, Daniel

AU - Hanel, Doug

AU - Merchant, Milind

AU - Rikli, Daniel A.

AU - Shafi, Mohamed

AU - Patiño, Juan M.

AU - Duncan, Scott F.

AU - Ballas, Efsthathios G.

AU - Harvey, Edward

AU - Walbeehm, E. T.

AU - Schumer, Evan D.

AU - Evans, Peter J.

AU - Suarez, Fabio

AU - Lopez-Gonzalez, Francisco

AU - Seibert, Franz Josef

AU - Desilva, Gregory L

AU - Bayne, Grant J.

AU - Guitton, T. G.

AU - Nancollas, Michael

AU - Lane, Lewis B.

AU - Westly, Stephen K.

AU - Villamizar, Harold Alonso

AU - Pountos, Ippokratis

AU - Hofmeister, Eric

AU - Biert, Jan

AU - Goslings, J. Carel

AU - Bishop, Julius

AU - Gillespie, James A.

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Purpose Surgical costs are under scrutiny and surgeons are being held increasingly responsible for cost containment. In some instances, implants are the largest component of total procedure cost, yet previous studies reveal that surgeons’ knowledge of implant prices is poor. Our study aims to (1) understand drivers behind implant selection and (2) assess whether educating surgeons about implant costs affects implant selection. Methods We surveyed 226 orthopedic surgeons across 6 continents. The survey presented 8 clinical cases of upper extremity fractures with history, radiographs, and implant options. Surgeons were randomized to receive either a version with each implant's average selling price (“price-aware” group), or a version without prices (“price-naïve” group). Surgeons selected a surgical implant and ranked factors affecting implant choice. Descriptive statistics and univariate, multivariable, and subgroup analyses were performed. Results For cases offering implants within the same class (eg, volar locking plates), price-awareness reduced implant cost by 9% to 11%. When offered different models of distal radius volar locking plates, 25% of price-naïve surgeons selected the most expensive plate compared with only 7% of price-aware surgeons. For cases offering different classes of implants (eg, plate vs external fixator), there was no difference in implant choice between price-aware and price-naïve surgeons. Familiarity with the implant was the most common reason for choosing an implant in both groups (35% vs 46%). Price-aware surgeons were more likely to rank cost as a factor (29% vs 21%). Conclusions Price awareness significantly influences surgeons’ choice of a specific model within the same implant class. Merely including prices with a list of implants leads surgeons to select less expensive implants. This implies that an untapped opportunity exists to reduce surgical expenditures simply by enhancing surgeons’ cost awareness. Type of study/level of evidence Economic/Decision Analyses I.

AB - Purpose Surgical costs are under scrutiny and surgeons are being held increasingly responsible for cost containment. In some instances, implants are the largest component of total procedure cost, yet previous studies reveal that surgeons’ knowledge of implant prices is poor. Our study aims to (1) understand drivers behind implant selection and (2) assess whether educating surgeons about implant costs affects implant selection. Methods We surveyed 226 orthopedic surgeons across 6 continents. The survey presented 8 clinical cases of upper extremity fractures with history, radiographs, and implant options. Surgeons were randomized to receive either a version with each implant's average selling price (“price-aware” group), or a version without prices (“price-naïve” group). Surgeons selected a surgical implant and ranked factors affecting implant choice. Descriptive statistics and univariate, multivariable, and subgroup analyses were performed. Results For cases offering implants within the same class (eg, volar locking plates), price-awareness reduced implant cost by 9% to 11%. When offered different models of distal radius volar locking plates, 25% of price-naïve surgeons selected the most expensive plate compared with only 7% of price-aware surgeons. For cases offering different classes of implants (eg, plate vs external fixator), there was no difference in implant choice between price-aware and price-naïve surgeons. Familiarity with the implant was the most common reason for choosing an implant in both groups (35% vs 46%). Price-aware surgeons were more likely to rank cost as a factor (29% vs 21%). Conclusions Price awareness significantly influences surgeons’ choice of a specific model within the same implant class. Merely including prices with a list of implants leads surgeons to select less expensive implants. This implies that an untapped opportunity exists to reduce surgical expenditures simply by enhancing surgeons’ cost awareness. Type of study/level of evidence Economic/Decision Analyses I.

KW - Cost

KW - implant

KW - price

KW - surgeon

KW - survey

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