Sharp spending hike seen for 10 costliest procedures

The number of dollars required to pay for each of the 10 most expensive hospital procedures grew at rates that far outpaced the increase in average yearly hospital care costs, according to a report issued Dec. 2 by the Agency for Healthcare Research and Quality (link).

Experts say the growth in these numbers are most likely due to more people accessing these services and advancements in technology that have made the procedures more successful, albeit more costly.

"We cannot just look at the cost of the procedure," said Elena Losina, PhD, associate professor of orthopedics at Brigham and Women's Hospital in Boston. "We need to know what that investment is buying. We still need to figure out how to pay for it, but the value should be assessed by the cost per quality-adjusted life years."

Researchers analyzed inflation-adjusted data from the agency's Healthcare Cost and Utilization Project. The total cost of hospital care grew 6.3% from 2004 to 2007 to a total of $344 billion, but the expense associated with bone marrow transplants grew 84.9% to $1.3 billion, the highest percentage growth of any procedure in the top 10. The amount spent on open prostatectomy went up 68.6% to $1 billion. Other procedures that saw significant spending hikes included aortic resection, cancer chemotherapy, spinal fusion and knee replacement.

These figures do not include the cost of physician services, and the reasons behind these increases most likely differ by procedure. For example, the total cost associated with spinal fusion went up by 29.5% to $8.9 billion, but the number of hospitals stays for the procedure rose by only 15.6%. Experts believe improvements in technology have made the procedure more expensive.

"Spinal disorders are a major source of disability in this country. We now have the ways and means to decrease that," said Joseph Zuckerman, MD, president of the American Academy of Orthopaedic Surgeons.

Other procedures are increasing primarily because of a growth in need created by the aging of the population and the obesity epidemic. For example, the amount of money spent on knee replacements rose 27.5% to $9.2 billion, the biggest outlay among the top 10.

"Knee replacement is one of the most successful surgical procedures that can be performed, and the population wants to remain more active. We have noticed that an increasing number of knee replacements are done," said Dr. Zuckerman, who is also professor and chair of the Dept. of Orthopaedic Surgery at the NYU Hospital for Joint Diseases.

Experts suspect these overall trends are unlikely to have changed in the past year's economic downturn because the procedures included in the AHRQ's report are usually done in urgent situations.