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

• Published in: The Journal of hand surgery (American ed.) Vol. 42; no. 8; pp. 593 - 601.e6
• Main Authors: Wasterlain, Amy S., MD, Melamed, Eitan, MD, Bello, Ricardo, MD, MPH, Karia, Raj, MPH, Capo, John T., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2017
• Subjects: Attitude of Health Personnel; Choice Behavior; Cost; Female; Health Care Costs; Humans; implant; Male; Orthopedic Surgeons - psychology; Orthopedics; Practice Patterns, Physicians' - economics; price; Prostheses and Implants - economics; surgeon; survey; Surveys and Questionnaires; survey; implant; Cost; price; surgeon
• ISSN: 0363-5023; 1531-6564
• DOI: 10.1016/j.jhsa.2017.05.005

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.