• Harald Effenberger, Stefan Rehart, Marc D Zumstein, and Alexander Schuh.
• Orthopaedic University Hospital Friedrichsheim, Marienburgstrasse 2, 60528 Frankfurt a. M, Germany. Effenberger@implantat-atlas.com
• Arch Orthop Trauma Surg. 2008 Dec 1;128(12):1349-56.

IntroductionFlat rate payment and "diagnosis related groups" (DRG) in knee arthroplasty offer incentives to save expenses. A cost-benefit analysis exactly compares all expenses to revenues. This requires patient-related assessment of treatment costs in terms of cost-unit accounting. This study compared expenses of knee arthroplasty in Austrian, German and Swiss clinics.Materials And MethodsA survey of primary and revision surgery was conducted and data-divided into cost elements and cost centers-were collected from three Austrian, five German and one Swiss clinic.ResultsPersonnel costs for medical services were lower in Austria (617 euro) than Germany (1,271 euro) and Switzerland (1,305 euro). Nursing costs amounted to 1,432 euro in Austria, 1,011 euro in Germany, 2,525 euro in Switzerland. Costs for med.-tech. services were lower in Austria (261 euro) than Germany (848 euro) and Switzerland (1,093 euro). Average costs for medication amounted to 491 euro in Austria, higher than Germany (118 euro), lower than Switzerland (506 euro). Costs for implants were higher in Austria (2,558 euro) than Germany (2,134 euro), highest in Switzerland (3,619 euro). Regarding case numbers, these cost elements showed significant differences (P< 0.001). Costs for non-medical goods were similar (Austria 478 euro, Germany 427 euro, Switzerland 488 euro). Personnel and material infrastructure was higher in Austria (516 euro) than Germany (360 euro); 1,658 euro in Switzerland. Administration was much higher in Austria (2,330 euro) than Germany (1,461 euro) and Switzerland (1,431 euro). Costs for primary knee arthroplasty amounted to 8,684 euro in Austria, 7,631 euro in Germany, 12,625 euro in Switzerland.ConclusionsThe proportion for personnel costs (medical, nursing, med.-tech.) of total costs was higher in Germany (41%) than Austria (26.6%) and Switzerland (39.9%). Implant costs were proportionally nearly the same in Austria (29.5%) than Germany (28%) and Switzerland (28.7%). Administration was proportionally higher in Austria (26.8%) than Germany (19.1%) and Switzerland (11.3%). To lower the costs, the expenses for personnel and implants must be reduced. Ultimately, the potential for hospitals to save costs can be found here.

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