• Daniëlle E Brunenberg, Mike J van Steyn, Judith C Sluimer, Linda L Bekebrede, Sjoerd K Bulstra, and Manuela A Joore.
• Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital, Maastricht, The Netherlands. dbru@kemta.azm.nl
• Med Care. 2005 Oct 1;43(10):1018-26.

ObjectiveThe objective of the present study was to determine the incremental cost-effectiveness of a clinical pathway for patients undergoing joint replacement, the Joint Recovery Programme (JRP), as compared with usual care. The existing care process was revised to contain costs and shorten waiting lists by facilitating patient flows and improve healthcare efficiency.MethodsThe study design was a before-after trial. In total, 160 patients undergoing total hip and total knee replacement, aged 28 to 87 years (mean age, 64.4 years), were treated either according to the Joint Recovery Programme (a standardized care process with patient education and rehabilitation in groups) or usual care. Both groups were followed for 1 year. Costs were studied from a societal perspective. Outcomes included functional level (Harris Hip score and American Knee Society score) and generic quality of life (EuroQol).ResultsThe results indicate that the Joint Recovery Programme resulted in a significant cost saving when compared with usual care mainly as a result of a considerable (>50%) reduction in length of hospital stay. The average cost saving per patient amounted to $1261 in the total hip replacement group and $3336 in the total knee replacement group. At the same time, both functional level and quality of life were higher in the JRP group.ConclusionsClinical pathway dominates usual care and is a highly cost-effective approach to contain costs related to joint replacement surgery without adverse consequences for patients.

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