1. MANAGING ORTHOPEDIC IMPLANTS COSTS
FREDRICK WAMBU
THE NAIROBI HOSPITAL

2. THA Implants

3. Knee Replacement—Implants
Patellar component

4. TJA Volume Estimates

5. 2016 NH- JAN FEB MARCH APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC TOTAL61 16 24 27 13 19 9 18 23 21
218
ORTHOPEDIC 71 64 67 77 40 69 73
106 76 79 66
864
ARTHROSCOPY KNEE 4 7 8 14 6 5 86
ARTHROSCOPY SHOULDER 3 2
MAXILLOFACIAL 22 20 30
276
TOTAL HIP REPLACEMENT 1 35
TOTAL KNEE REPLACEMENT

6. GROWTH DRIVERS IN ORTHOPEDICS
Growth in patient base (obesity, osteoarthritis and osteoporosis)
Increase in aging population
Untapped and expanding healthcare access –NHIF &Insurance coverage
Improvement in quality health care delivery
Promotion of medical tourism
Increase in sports and musculoskeletal injuries.

7. ORTHOPEDIC IMPLANT MARKET SEGMENT
Based on area of treatment
Trauma
Spine
Knee replacement
Hip replacement
Sports medicine

8. CHOICE OF IMPLANTS Depends on : Positive patient outcome
Product quality
Ease of use of implants
Convenience
Vendor support

9. Implant market players
Dominated by multinationals and is fast evolving :
Depuy synthes
Zimmer
Smith& Nephew
Medtronic
Athrex
Others

10. Implant distribution structure
Private hospitals : Distributors ,vendors .-Sales depend on relationships between surgeons distributors & sales reps
Public hospitals: Though tender awards price consideration is a critical factor.

11. The realities on orthopedic implants
New technology entering the market
Transforming patient needs
Changing surgeon preferences
Demand for implants is a huge financial cost to hospitals
Surgeons are the ultimate decision makers on choice of implants

12. Stakeholders in the orthopedic implants
Surgeons
Patients
Payers .(Health insurance)
Hospitals
Manufacturers /Implant distributors

13. Cost drivers in orthopedics implants
Greater demand for services
New technology
Cost shift due to underfunded public health programs
Government regulation mandate
Medical malpractice liability
High administrative costs
Hospital fees and surgeons fees.

14. Challenges in managing orthopedic implant costs
Implants world is clinically and surgeon sensitive .-Personal preferences
A balance between quality patient care while sustaining cost considerations
Rising costs of implants .
Hospital financial performance .

15. Strategies to manage costs
Orthopedic surgery committees – Review and advice on implant management
Hospital policies on implant /vendor contracts
Sole source vendor –Pricing standardization
Price/Cost transparency .
Hospitals Sharing of Data on implant spend with surgeons and implant suppliers

16. Strategies to manage implant costs
Team work- Senior hospital leadership and surgeons to agree on strategies/choices made by stakeholders -Surgeon engagement.
Economic alignment between hospitals ,orthopedic surgeons and suppliers/manufacturers
Operating room efficiency to reduce costs
Benchmarking among institutions on best practices and costs
Reducing reliance on sales rep in the operating theatres –vendor less operating room

17. Summary Managing cost is a challenge and an ongoing debate
Hospitals must build a quality case while managing implants costs .
Key stakeholders must openly discuss this issue and adopt the best strategy that works for their facility

18. References
Mulimba, J.A.O. Total hip arthroplasty experience in a developing African country. East Afr. Ortho. J. 2007; 1: 68-73
 Burns LR, Housman MG, Booth RE Jr, Koenig A. Implant vendors and hospitals:competing influences over product choice by orthopedic surgeons. Health Care Manage Rev. 2009;34(1):2-18.
Rohman L, Hadi S, Whitwell G. Surgeons' knowledge about the costs of orthopaedic implants. J Orthop Surg (Hong Kong). 2014;22(2):
Streit JJ, Youssef A, Coale RM, Carpenter JE, Marcus RE. Orthopaedic surgeons frequently underestimate the cost of orthopaedic implants. Clin Orthop Relat Res .2013;471(6):