The Role of Crosslinked Polyethylene in Reducing Aggregated Costs of Total Hip Arthroplasty in the United States.

BACKGROUND: Widespread adoption of crosslinked polyethylene for the acetabular articular surface for total hip arthroplasty has substantially reduced revision rates and dislocation rates. We aim to provide estimates of the resulting magnitude of the annual reduction in aggregated costs of total hip arthroplasty surgery in the United States. METHODS: After we obtained, from the literature, the contrasting mid-term rates of revisions and dislocations of total hip arthroplasty using conventional polyethylene vs those using crosslinked polyethylene, specifically from only registry studies and prospective, randomized controlled studies, we multiplied these incidence figures by the cost estimates of these failures to generate approximations of the cost savings in the United States from the use of crosslinked polyethylene. RESULTS: The estimates suggest that in the United States these savings might be one billion dollars per annual cohort over a 15-year duration. CONCLUSION: The use of crosslinked polyethylene has reduced substantially the overall costs of total hip arthroplasty surgery in the United States.

Are Ceramic Bearings Becoming Cost-Effective for All Patients Within a 90-Day Bundled Payment Period?

BACKGROUND: We analyzed whether the total hospital cost in a 90-day bundled payment period for ceramic-on-polyethylene (C-PE) and ceramic-on-ceramic (COC) total hip arthroplasty (THA) bearings was changing over time, and whether the cost differential between ceramic bearings and metal-on-polyethylene (M-PE) bearings was approaching the previously published tipping point for cost-effectiveness of US$325. METHODS: A total of 245,077 elderly Medicare patients (65+) who underwent primary THA between 2010 and 2015 were identified from the United States Medicare 100% national administrative hospital claims database. The total inpatient cost, calculated up to 90 days after index discharge, was computed using cost-to-charge ratios, and hospital payment was analyzed. The differential total inpatient cost of C-PE and COC bearings, compared to metal-on-polyethylene (M-PE), was evaluated using parametric and nonparametric models. RESULTS: After adjustment for patient and clinical factors, and the year of surgery, the mean hospital cost up to 90 days for primary THA with C-PE or COC was within ±1% of the cost for primary THA with M-PE bearings (P < .001). From the nonparametric analysis, the median total hospital cost was US$296-US$353 more for C-PE and COC than M-PE. Cost differentials were found to decrease significantly over time (P < .001). CONCLUSION: Patient and clinical factors had a far greater impact on the total cost of inpatient THA surgery than bearing selection, even when including readmission costs up to 90 days after discharge. Our findings indicate that the cost-effectiveness thresholds for ceramic bearings relative to M-PE are changing over time and increasingly achievable for the Medicare population.

Economics of All-Polyethylene Versus Metal-Backed Tibial Prosthesis Designs.

With the large number of total knee arthroplasties being performed and expectations that these numbers will be on the rise over the coming decades, efforts to provide cost-efficient care are of greater interest. The preferred design of knee arthroplasty implants has changed over time, with the original all-polyethylene tibial (APT) design being replaced by metal-backed tibial (MBT) components, as well as more recent considerations of newer APT designs. Modern APT components have been shown to have similar or superior outcomes than MBT components. Despite their limitations, APT components can be used to reduce the economic burden to the provider, medical institution, and health care system as a whole. There is a paucity of evidence-based literature directly comparing the cost associated with APT and MBT components. The purpose of this report is to review the literature to assess the available data regarding direct and indirect costs of both designs so that orthopedic surgeons can account for economic differences in everyday practice. [Orthopedics. 2016; 39(3):S61-S66.].

Changing the renewable fuel standard to a renewable material standard: bioethylene case study.

The narrow scope of the U.S. renewable fuel standard (RFS2) is a missed opportunity to spur a wider range of biomass use. This is especially relevant as RFS2 targets are being missed due to demand-side limitations for ethanol consumption. This paper examines the greenhouse gas (GHG) implications of a more flexible policy based on RFS2, which includes credits for chemical use of bioethanol (to produce bioethylene). A Monte Carlo simulation is employed to estimate the life-cycle GHG emissions of conventional low-density polyethylene (LDPE), made from natural gas derived ethane (mean: 1.8 kg CO2e/kg LDPE). The life-cycle GHG emissions from bioethanol and bio-LDPE are examined for three biomass feedstocks: U.S. corn (mean: 97g CO2e/MJ and 2.6 kg CO2e/kg LDPE), U.S. switchgrass (mean: -18g CO2e/MJ and -2.9 kg CO2e/kg LDPE), and Brazilian sugar cane (mean: 33g CO2e/MJ and -1.3 kg CO2e/kg LDPE); bioproduct and fossil-product emissions are compared. Results suggest that neither corn product (bioethanol or bio-LDPE) can meet regulatory GHG targets, while switchgrass and sugar cane ethanol and bio-LDPE likely do. For U.S. production, bioethanol achieves slightly greater GHG reductions than bio-LDPE. For imported Brazilian products, bio-LDPE achieves greater GHG reductions than bioethanol. An expanded policy that includes bio-LDPE provides added flexibility without compromising GHG targets.

Environmental and economic assessment of a road safety product made with virgin and recycled HDPE: a comparative study.

The development of value-added products made from post-consumer plastic recyclates has become an important goal in the quest for a sustainable society. To attain such goal, tools with higher accuracy and wider scope are increasingly necessary. The present work describes the application of a Life Cycle Assessment (LCA)/Life Cycle Costing (LCC) integrated model, with inclusion of externalities (environmental and social costs), to Anti-Glare Lamellae (AGL) made with High Density Polyethylene (HDPE). It compares an AGL currently manufactured from virgin HDPE (current AGL) with an alternative one made with recycled HDPE (optional AGL). The results obtained show that neither the current nor the optional AGL depict the best environmental performance in all impact categories. Nevertheless, there is a clear overall environmental and economic advantage in replacing virgin HDPE with recycled HDPE. The present work also makes evident that the LCA/LCC integrated model allows the identification of economic and environmental win-win and trade-off situations related to the full life cycle of products. As such, its results can be used as valuable guidelines in product development.

Reduction of plastic carrier bag use: An analysis of alternatives in Israel.

Plastic carrier bags have been drawing the attention of the public and politicians. Different policy measures to reduce the environmental burden of these bags have been implemented and more are planned. The research analyzed the actual environmental aspects of consumption and use of plastic carrier bags and assessed the effectiveness of the proposed regulation in Israel. Since plastic bags are provided free of charge, people have a tendency to use these bags excessively, therefore a rigorous educational program should address this trend. However, the environmental load imposed by the bags is more a politically correct issue than an actual environmental hazard, and therefore the means for reducing their use should not include a high levy or total elimination of these bags.