In-office needle arthroscopy is a cost-effective alternative for operating room diversion in medial meniscectomy: a financial analysis

Abstract

Background: In-office needle arthroscopy (IONA) has been described as a diagnostic alternative to magnetic resonance imaging (MRI) for intra-articular pathology. However, few studies have analyzed its impact on cost and wait times when used as a therapeutic intervention. The purpose of this study was to investigate the impact on cost and wait times associated with offering IONA for partial medial meniscectomy as an alternative to traditional operating room (OR) arthroscopy for patients with irreparable medial meniscus tears on MRI.

Methods: Two models were created comparing the existing care pathway (current state) to a proposed future state utilizing IONA. Data sources were accounting data from an academically affiliated hospital in Canada and supplemented with literature values. A Monte Carlo simulation combined with DuPont analysis running 10,000 simulations was conducted to calculate the revenue, expenses, profits, and effect on surgical waitlists (i.e., throughput) between the states. Sensitivity analyses examined the influence of patient preference and revision rates on profit and throughput. Two-sample Student's t test was performed (p < .05).

Results: An average of 198 (standard deviation (SD) 31) patients underwent arthroscopic meniscectomy or repair each year from 2016 to 2020. The IONA revision rate was calculated as 20.3%. Compared to the current state, annual expenses in the IONA pathway were significantly reduced ($266,912.68 versus $281,415.23, p < .0001), while improving throughput by 21.2% (3.54%). Sensitivity analysis revealed 10% of patients need to select IONA over traditional OR arthroscopy with the revision rate remaining below 40% for the proposed state profit to be higher than the current state.

Conclusions: IONA is a cost-effective alternative to traditional OR arthroscopy in patients undergoing partial medial meniscectomy. The next steps are to assess patients' perceptions of IONA as an alternative to traditional OR arthroscopy, and to carry out clinical trials to determine the efficacy, patient-reported outcome metrics, and complications of IONA.

Keywords: Arthroscopy; Cost-effectiveness; Efficiency; In-office; Needle; Wait times.

Fig. 1

Current (black) versus proposed (black and orange) pathway for patients with a medial meniscus tear on MRI

Fig. 2

Current (black) and proposed (black and orange) state DuPont financial tree derived from process mapping

Fig. 3

Financial sensitivity analysis. Effect of (1) percentage of patients who opt to receive IONA (rows) and (2) percentage of IONA revisions (columns) on the proposed state profit (CAD) and profit margin (%). For the profit table, green indicates profit > 0, yellow indicates 0 > profit > current state profit, and red indicates profit < current state profit. For the profit margin table, green indicates profit margin > 0, yellow indicates 0 > profit margin > current state profit margin, and red indicates profit margin < current state profit margin

Fig. 4

Throughput sensitivity analysis. Effect of (1) percentage of patients who opt to receive IONA (rows) and (2) percentage of IONA revisions (columns) on the throughput (numbers) and throughput (%). For both the numbers and percentages tables, green indicates throughput > heuristics model throughput, yellow indicates heuristics model throughout > throughput > 0, and red indicates throughput < 0 for numbers and percentages, respectively