Objectives: To analyze the effectiveness of an implant stewardship program on implant cost containment and to estimate surgeons' responsiveness to implant price changes.
Design: Interrupted time series.
Setting: Level I trauma center.
Patients/participants: Monitored usage of 5 trauma constructs by 10 surgeons over a 5-year period.
Intervention: Red-Yellow-Green (RYG) implant pricing comparison chart.
Main outcome measurements: 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.
Results: 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).
Conclusions: 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.
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