The Cost Variability of Orthobiologics

Background: Mixed results exist regarding the benefit of orthobiologic injections. The purpose of this study was to assess the variability in costs for platelet-rich plasma (PRP) and stem cell (SC) injections and evaluate for variables that influence pricing. Hypothesis: There will be significant variability in the cost of PRP and SC injections throughout the United States. Study Design: Descriptive epidemiology study. Level of Evidence: Level 3. Methods: Calls were made to 1345 orthopaedic sports medicine practices across the United States inquiring into the availability of PRP or SC knee injections and associated costs. In addition to pricing, the practice type, number of providers, and population and income demographics were recorded. Univariate statistical analyses were used to identify differences in availability and cost between variables. Results: Of the contacted offices that provided information on both PRP and SC availability (n = 1325), 268 (20.2%) offered both treatments, 550 (41.5%) offered only PRP injections, 20 (1.5%) offered only SC injections, and 487 (36.8%) did not offer either treatment. The mean ± SD cost of a PRP injection was $707 ± $388 (range, $175-$4973), and the mean cost of an SC injection was $2728 ± $1584 (range, $300-$12,000). Practices offering PRP and SC injections tended to be larger (PRP, 12.0 physicians per practice vs. 8.1 [ P < 0.001]; SC, 13.6 vs 9.7 [ P < 0.001]). Practices that offered PRP injections were located in areas with higher median household income ( P = 0.047). Variables associated with higher cost of PRP injections included city population ( P < 0.001) and median income of residents ( P < 0.001). Conclusion: While the majority of sports medicine practices across the United States offer some type of orthobiologic injection, there exists significant variability in the cost of these injections. Clinical Relevance: This study demonstrates the significant variability in costs of orthobiologic injections throughout the country, which will allow sports medicine physicians to appreciate the value of these injections when counseling patients on available treatment options.

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The Cost Variability of Orthobiologics

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00285 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0028

Author(s):

Brent Ponce ◽

Andrew McGee ◽

Alex Dombrowsky ◽

Raymond Waldrop ◽

Joshua Wild ◽

...

Keyword(s):

United States ◽

Stem Cell ◽

Sports Medicine ◽

Platelet Rich Plasma ◽

The United States ◽

City Population ◽

The Mean ◽

Cost Variability ◽

The Cost ◽

Mean Cost

Objectives: Despite limited clinical data, many orthopedic practices offer orthobiologic injections. Such injections are not covered by insurance, and thus patients pay out of pocket for these treatments. The purpose of this study was to assess the variability in costs for platelet rich plasma (PRP) and stem cell (SC) injections across practices and evaluate for variables that influence pricing. Methods: A list of 1,345 orthopedic sports medicine practices across the United States was compiled. Calls were made inquiring into the availability of PRP or SC knee injections and associated costs. In addition to pricing, practice type (academic or private), number of providers, and population and income demographics were recorded. Univariate statistical analyses were used to identify differences in availability and cost between variables. Results: Of the contacted offices, 268 (20.2%) offered both treatments, 550 (41.5%) offered only PRP injections, 20 (1.5%) offered only stem cell injections, and 487 (36.2%) did not offer either treatment. The mean (± SD) cost of a PRP injection was $707 ± $388 (range, $175 to $4,973), and the mean cost of a SC injection was $2,728 ± $1,584 (range, $300 to $12,000). Practices offering PRP and SC injections tended to be larger (for PRP - 11.6 physicians per practice vs. 8.1, P<0.001; for SC - 12.3 vs. 9.7, P=0.006). In addition, practices that offered PRP injections were located in areas with higher mean income ($67,500 vs. $64,300, P=0.047). Variables associated with higher cost of PRP injection included city population (P<0.001) and mean income of residents (P<0.001). Conclusion: While the majority of sports medicine practices across the United States offer some type of orthobiologic injection, there exists significant variability in the cost of these injections. The cost for PRP injections is higher in practices located in highly populated areas and in areas with greater mean incomes.

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The cost of linguistic loyalty

Spanish in Context ◽

10.1075/sic.6.1.02jen ◽

2009 ◽

Vol 6 (1) ◽

pp. 7-25 ◽

Cited By ~ 4

Author(s):

Devin L. Jenkins

Keyword(s):

United States ◽

Language Maintenance ◽

Census Data ◽

The United States ◽

Spanish Language ◽

Median Income ◽

Social Variables ◽

Model Set ◽

The Cost ◽

The Relationship

In a census-related study on language maintenance among the Hispanic/Latino population in the southwest United States, Hudson, Hernández-Chávez and Bills (1995) stated that, given negative correlations between language maintenance and years of education and per capita income, “educational and economic success in the Spanish origin population are purchased at the expense of Spanish language maintenance in the home” (1995: 179). While census figures from 1980 make this statement undeniable for the Southwest, the recent growth of the Spanish-language population in the United States, which has grown by a factor of ~2.5 over the last twenty years, begs a reexamination of these correlations. A recent study on the state of Colorado (McCullough & Jenkins 2005) found a correlational weakening, especially with regard to the relationship between language maintenance and median income.  The current study follows the model set forth by Hudson et al. (1995) in examining the interrelationship between the measures of count, density, language loyalty and retention based on 2000 census data, as well as the relationship between these metrics and socioeconomic and demographic variables, including income and education. While some relationships existed in 2000 much in the same way that they did in the 1980 data, especially with regard to count and density, the measures of loyalty and retention saw marked reductions in their correlations with social variables.

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What Is the Price and Claimed Efficacy of Platelet-Rich Plasma Injections for the Treatment of Knee Osteoarthritis in the United States?

The Journal of Knee Surgery ◽

10.1055/s-0038-1669953 ◽

2018 ◽

Vol 32 (09) ◽

pp. 879-885 ◽

Cited By ~ 8

Author(s):

Nicolas S. Piuzzi ◽

Mitchell Ng ◽

Ariel Kantor ◽

Kenneth Ng ◽

Stephanie Kha ◽

...

Keyword(s):

United States ◽

Standard Deviation ◽

Knee Osteoarthritis ◽

Clinical Efficacy ◽

Health Care Providers ◽

Platelet Rich Plasma ◽

The United States ◽

Care Providers ◽

Knee Oa ◽

The Mean

AbstractPlatelet-rich plasma (PRP) injections are often used for the treatment of knee osteoarthritis (OA), despite clinical value and cost-effectiveness not being definitely established. PRP injections are considered as a potential means of reducing pain and improving function in patients with knee OA, in the hope of delaying or avoiding the need for surgical intervention. Centers that offer PRP injections usually charge patients out of pocket and directly market services. Therefore, the purpose of this study was to quantify the current (1) prices and (2) marketed clinical efficacy of autologous PRP injections for knee OA. A prospective cross-sectional study was performed based on 286 centers identified in the United States offering PRP injections for knee OA. A total of 179 (73.4%) centers were successfully contacted via e-mail or phone, using a simulated 52-year-old male patient with knee OA. Scripted questions were asked by the simulated patient to determine the current marketed prices and clinical efficacy, either reported as “good results” or “symptomatic improvement,” claimed by each treating center. The mean price for a single unilateral knee same-day PRP injection was $714 with a standard deviation of $144 (95% confidence interval [CI]: $691–737, n = 153). The mean claim of clinical efficacy was 76% with a standard deviation of 11% (95% CI: 73.5–78.3%, n = 84). Out of the 84 clinics, 10 claimed “90 to 100% efficacy,” 27 claimed “80 to 90%,” 29 claimed “70 to 80%,” 9 claimed “60 to 70%,” 8 claimed “50 to 60%,” and 1 claimed “40 to 60%.” These findings provide a unique perspective on the PRP market for the treatment of knee OA that is valuable to physicians and health care providers in providing better education to patients on the associated costs and purported clinical benefits of PRP injections.

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Comprehensive survey of United States internet users’ sentiments towards cryopreservation

PLoS ONE ◽

10.1371/journal.pone.0244980 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0244980

Author(s):

Christopher Robert Gillett ◽

Taylor Brame ◽

Emil F. Kendiorra

Keyword(s):

United States ◽

Low Temperatures ◽

The United States ◽

Fear Of Death ◽

Cryoprotective Agents ◽

Internet Users ◽

Comprehensive Survey ◽

Attitudes Towards Death ◽

The Mean ◽

The Cost

Medical cryopreservation is the speculative practice of using low temperatures and medical-grade cryoprotective agents to halt the decay of a recently-deceased person’s brain and body for the prospect of future resuscitation and restoration of function. We conducted a survey of 1,487 internet users in the United States to measure familiarity with, interest in, beliefs about, and attitudes towards cryopreservation. The majority of respondents (75%) had previously heard of the topic. Respondents tended to underestimate the cost of cryopreservation and number of previous cases but overestimate the number of providers. While many respondents expressed interest in signing up (20%) or had actively researched the topic (21%), a much smaller fraction have decided to be cryopreserved (6%). This level of interest is much greater than the number of previous preservation cases would indicate. We found that respondents’ attitudes towards death significantly correlated with their general sentiments towards the topic, with those expressing a desire for longer life or to see the future being more interested and positively inclined. Fear of death was not associated with interest in cryopreservation. Negative sentiments towards cryopreservation were less common than respondents perceived. For example, 14% of respondents believed that “most people” think cryopreservation should be illegal, but only 4% of respondents actually did. Many respondents (42%) were pessimistic regarding the likelihood of cryopreservation being successful, but the mean estimate of time until revival of cryopreserved bodies would be possible was 82 years.

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Intermediate-term Experience With the STAR Total Ankle in the United States

Foot & Ankle International ◽

10.1177/1071100718808743 ◽

2018 ◽

Vol 40 (3) ◽

pp. 268-275 ◽

Cited By ~ 2

Author(s):

Evan M. Loewy ◽

Thomas H. Sanders ◽

Arthur K. Walling

Keyword(s):

United States ◽

Perioperative Complications ◽

Case Series ◽

Major Complication ◽

The United States ◽

Complication Rates ◽

Level Of Evidence ◽

Patient Reported ◽

The Mean

Background: Limited intermediate and no real long-term follow-up data have been published for total ankle arthroplasty (TAA) in the United States. This is a report of clinical follow-up data of a prospective, consecutive cohort of patients who underwent TAA by a single surgeon from 1999 to 2013 with the Scandinavian Total Ankle Replacement (STAR) prosthesis. Methods: Patients undergoing TAA at a single US institution were enrolled into a prospective study. These patients were followed at regular intervals with history, physical examination, and radiographs; American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale scores were obtained and recorded. Primary outcomes included implant survivability and functional outcomes scores. Secondary outcomes included perioperative complications such as periprosthetic or polyethylene fracture. Between 1999 and 2013, a total of 138 STAR TAAs were performed in 131 patients; 81 patients were female. The mean age at surgery was 61.5 ± 12.3 years (range, 30-88 years). The mean duration of follow-up for living patients who retained both initial components at final follow-up was 8.8±4.3 years (range 2-16.9 years). Results: The mean change in AOFAS Ankle-Hindfoot scores from preoperative to final follow-up was 36.0 ± 16.8 ( P < .0001). There were 21 (15.2%) implant failures that occurred at a mean 4.9 ± 4.5 years postoperation. Ten polyethylene components in 9 TAAs (6.5%) required replacement for fracture at an average 8.9 ± 3.3 years postoperatively. Fourteen patients died with their initial implants in place. Conclusion: This cohort of patients with true intermediate follow-up after TAA with the STAR prosthesis had acceptable implant survival, maintenance of improved patient-reported outcome scores, and low major complication rates. Level of Evidence: Level IV, case series.

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AB0870-HPR GLOBAL TRENDS IN PRP AND OSTEOARTHRITIS: A BIBLIOMETRIC AND VISUALIZED STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2849 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1458.3-1459

Author(s):

Y. Qiu ◽

Y. Zhang ◽

L. Wen

Keyword(s):

United States ◽

Sports Medicine ◽

Platelet Rich Plasma ◽

Development Trend ◽

The United States ◽

Global Trends ◽

Social Burden ◽

Sports Science ◽

The Uk ◽

Visualized Study

Background:Osteoarthritis (OA) is a serious disease, which is one of the main causes of joint pain and body dysfunction, raising serious economic and social burden. In recent years, there are tremendous articles on the treatment of osteoarthritis, platelet rich plasma (PRP) is one of the new trends in the treatment of osteoarthritis.Objectives:The purpose of this study is to explore the development trend of PRP related osteoarthritis study and grasp the hot spots and directions in this field.Methods:Publications focusing on PRP related osteoarthritis research from 2001 to 2020 were retrieved from Web of Science (WoS) and Science Citation Index-Expanded (SCIE) database. The retrieving methods were as follow: (theme = platelet rich plasma arthritis OR theme = platelet rich plasma osteoarthritis OR theme = platelet rich plasma cartilage OR theme = platelet rich plasma knee OR theme = platelet rich plasma orthopedic OR theme = platelet rich plasma orthopaedic OR theme = platelet rich plasma articular OR theme = platelet rich plasma joint OR theme = platelet rich plasma tendon). Publications were analyzed only when type is articles or reviews. The VOS viewer was used for the generation of bibliographic coupling and visualized study.Results:A total of 2847 publications were retrieved, including 2636 articles and reviews. Before 2000, there were only 15 relevant papers, which were not included in the specific analysis. It is clear that the number of publications on PRP related OA study is increasing every year, a total of 398 articles or reviews were published in 2020. The United States is the leading country in this field, with a number of 932 publications (35.4%), followed by Italy (304 publications, 11.5%) and China (294 publications, 11.2%). The most prevalent areas of PRP related OA research were orthopedics (1013 papers, 38.4%), sports science (651 papers, 24.7%) and surgery (475 papers,18.0%). The top 3 journal that published the most PRP related OA study is American Journal of Sports Medicine (153 papers, 5.8%), Arthroscopy: The Journal of Arthroscopic & Related Surgery (95 papers, 3.6%), Journal of Orthopaedic Research (83 papers, 3.1%). The Harvard University (96 papers, 3.6%), Hospital for Special Surgery (83 papers, 3.1%) and University of London (75 papers, 2.8%) is the top 3 institution that published the most articles or reviews. Filardo G from Italy published the most articles or reviews (52, 2.0%) in this area, followed by Maffulli N from the UK (49 publications, 1.9%) and Kon E from Italy (46, 1.7%). PRP related OA study can be divided into five categories: intra-articular treatment study, clinical trials related study, soft tissue repairment study, gene and molecular biology study, regeneration and implantation study.Conclusion:Publications on PRP related OA study is increasing according to the analysis on current global trends. The United States is now the leading country in this field, with the largest number and the highest quality of publications. Among the five cluster of PRP related OA studies, “intra-articular treatment study” and “regeneration and implantation study” are considered to be the current research hotspots in the PRP related OA field.References:[1]Foster T E, Puskas B L, Mandelbaum B R, et al. Platelet-rich plasma: from basic science to clinical applications.[J]. American Journal of Sports Medicine, 2009, 37(11):2259-2272.Disclosure of Interests:None declared

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Trends of Hospitalization in Acute Pancreatitis in Patients in the United States from 2001-2014

10.31219/osf.io/zd8ab ◽

2019 ◽

Author(s):

Kevin Casey ◽

Roberto Argo ◽

Albert Bianco

Keyword(s):

United States ◽

Acute Pancreatitis ◽

Length Of Hospital Stay ◽

The United States ◽

Primary Objective ◽

Hospital Charges ◽

Cost Burden ◽

Patient Demographics ◽

The Mean ◽

The Cost

Background & Purpose: The prevalence of acute pancreatitis(AP) has increased over time and is one of the most important gastrointestinal causes of frequent admissions to hospital in the United States. The cost burden of AP has been steadily increasing. The primary objective of our study was to analyze patient demographics, cost burden, mortality and length of stay associated with AP hospital admissions.Methods: Nationwide inpatient sample (NIS) database was used to identify AP admissions in all patients from ≥18 years of age from 2001 to 2014 using ICD-9-CM code 577.0 as the principal discharge diagnosisResults: The number of hospitalizations increased from 215,238 in 2001 to 279,145 in 2014. In-hospital mortality decreased from 1.74% in 2001 to 0.66% in 2014. Mean length of hospital stay has decreased from 6.1 days to 4.6 days during the same period, but the mean hospital charges increased from $19,303 in 2001 to $35,728 in 2014. The proportion of males to females with acute pancreatitis is slowly trending up from 2001 to 2014. Conclusion: The number of hospitalizations due to acute pancreatitis has been steadily increasing, and further research needs to be done on finding out the reasons for increased causes of hospitalization and ways to decrease the cost burden on patients and hospitals.

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Assessment and Trends of the Methodological Quality of the Top 50 Most Cited Articles on Patellar Instability

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120972016 ◽

2021 ◽

Vol 9 (1) ◽

pp. 232596712097201

Author(s):

Avinesh Agarwalla ◽

Kaisen Yao ◽

Christon Darden ◽

Anirudh K. Gowd ◽

Seth L. Sherman ◽

...

Keyword(s):

Methodological Quality ◽

Patellar Instability ◽

Treatment Options ◽

The United States ◽

Level Of Evidence ◽

Cross Sectional ◽

Wide Range ◽

Significant Difference ◽

The Mean ◽

Number Of Citations

Background: Studies with a low level of evidence (LOE) have dominated the top cited research in many areas of orthopaedics. The wide range of treatment options for patellar instability necessitates an investigation to determine the types of studies that drive clinical practice. Purpose: To determine (1) the top 50 most cited articles on patellar instability and (2) the correlation between the number of citations and LOE or methodological quality. Study Design: Cross-sectional study. Methods: The Scopus and Web of Science databases were assessed to determine the top 50 most cited articles on patellar instability between 1985 and 2019. Bibliographic information, number of citations, and LOE were collected. Methodological quality was calculated using the Modified Coleman Methodology Score (MCMS) and the Methodological Index for Non-Randomized Studies (MINORS). Mean citations and mean citation density (citations per year) were correlated with LOE, MCMS, and MINORS scores. Results: Most studies were cadaveric (n = 10; 20.0%), published in the American Journal of Sports Medicine (n = 13; 26.0%), published between 2000 and 2009 (n = 41; 82.0%), and conducted in the United States (n = 17; 34.0%). The mean number of citations and the citation density were 158.61 ± 59.53 (range, 95.5-400.5) and 12.74 ± 5.12, respectively. The mean MCMS and MINORS scores were 59.62 ± 12.58 and 16.24 ± 3.72, respectively. No correlation was seen between mean number of citations or citation density versus LOE. A significant difference was found in the mean LOE of articles published between 1990 and 1999 (5.0 ± 0) versus those published between 2000 and 2009 (3.12 ± 1.38; P = .03) and between 2010 and 2019 (3.00 ± 1.10; P = .01). Conclusion: There was a shift in research from anatomy toward outcomes in patellar instability; however, these articles demonstrated low LOE and methodological quality. Higher quality studies are necessary to establish informed standards of management of patellar instability.

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A Bibliometric Analysis of the Top Cited Articles in Sports and Exercise Medicine

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120969902 ◽

2021 ◽

Vol 9 (1) ◽

pp. 232596712096990

Author(s):

Omeet Khatra ◽

Armita Shadgan ◽

Jack Taunton ◽

Amir Pakravan ◽

Babak Shadgan

Keyword(s):

United States ◽

Sports Medicine ◽

Controlled Trial ◽

Country Of Origin ◽

Well Being ◽

The United States ◽

Journal Title ◽

Exercise Medicine ◽

Sports And Exercise ◽

Study Type

Background: Although citation analysis is common in many areas of medicine, there is a lack of similar research in sports and exercise medicine. Purpose: To identify and examine the characteristics of the 100 top cited articles in the field of sports and exercise medicine in an effort to determine what components make an article highly influential. Study Design: Cross-sectional study. Methods: The Web of Science, Scopus, and PubMed databases were used to determine the 100 top cited articles from 46 journals in the field of sports and exercise medicine. Each of the 100 articles was then analyzed by 2 independent reviewers, and results were compared. Basic information was collected, including journal title, country of origin, and study type. Different categories were compared using descriptive statistics of counts or percentages. Results: The 100 top cited articles were published in 15 of the 46 identified sports and exercise medicine journals, with the most prolific being Medicine and Science in Sports and Exercise (n = 49), American Journal of Sports Medicine (n = 18), and Sports Medicine (n = 7). In terms of country of origin, the top 3 contributors were the United States (n = 65), Canada (n = 9), and Sweden (n = 8). The most commonly researched anatomic areas were the knee (n = 15) and the brain (n = 3). Narrative reviews were the most common study type (n = 38), and only a single study on the 100 top cited articles list used a randomized controlled trial design. The most prevalent fields of study were exercise science (55% of articles) and well-being (16% of articles). Conclusion: Narrative reviews from the United States and published in English-language journals were the most likely to be highly cited. In addition, the knee was a common anatomic area of study on the top cited list of research in sports and exercise medicine

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SWK-11. ASSESSMENT OF THE INDIRECT COSTS ASSOCIATED WITH PROTON THERAPY TREATMENT FOR ALBERTA PATIENTS REFERRED OUT OF COUNTRY

Neuro-Oncology ◽

10.1093/neuonc/noaa222.828 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii466-iii466

Author(s):

Karina Black ◽

Jackie Middleton ◽

Sunita Ghosh ◽

David Eisenstat ◽

Samor Patel

Keyword(s):

United States ◽

Proton Therapy ◽

Malignant Tumors ◽

Indirect Costs ◽

The United States ◽

Current Data ◽

Opportunity Costs ◽

Proton Treatment ◽

Out Of Pocket Expenses ◽

The Cost

Abstract BACKGROUND Proton therapy for benign and malignant tumors has dosimetric and clinical advantages over photon therapy. Patients in Alberta, Canada are referred to the United States for proton treatment. The Alberta Heath Care Insurance Plan (AHCIP) pays for the proton treatment and the cost of flights to and from the United States (direct costs). This study aimed to determine the out-of-pocket expenses incurred by patients or their families (indirect costs). METHODS Invitation letters linked to an electronic survey were mailed to patients treated with protons between 2008 and 2018. Expenses for flights for other family members, accommodations, transportation, food, passports, insurance, and opportunity costs including lost wages and productivity were measured. RESULTS Fifty-nine invitation letters were mailed. Seventeen surveys were completed (28.8% response rate). One paper survey was mailed at participant request. Nine respondents were from parent/guardian, 8 from patients. All patients were accompanied to the US by a family member/friend. Considerable variability in costs and reimbursements were reported. Many of the accompanying family/friends had to miss work; only 3 patients themselves reported missed work. Time away from work varied, and varied as to whether it was paid or unpaid time off. CONCLUSIONS Respondents incurred indirect monetary and opportunity costs which were not covered by AHCIP when traveling out of country for proton therapy. Prospective studies could help provide current data minimizing recall bias. These data may be helpful for administrators in assessing the societal cost of out-of-country referral of patients for proton therapy.

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