Osteoarthritis is a growing public health concern that increases with population aging, significantly impacting quality of life and imposing a rising economic burden on healthcare systems. This study aimed to analyze the cost of medical services for patients undergoing total knee arthroplasty (TKR), to study the factors influencing hospital costs and cost recovery of TKR. The data source was obtained from a multi cross-sectional study using individual inpatient cost data from voluntary hospitals in the cost of disease project, which calculated costs from a provider perspective and applied both top-down and bottom-up costing methods over five fiscal years (2018–2022). Patient data selection criteria included: (1) ICD-9-CM procedure code 8154 for total knee replacement; (2) patients classified under the disease cluster (DC) 0803 the knee replacement group by the Thai diagnosis related group (TDRG) version 6.3; (3) hospital stay at least three days; (4) the charge of Instrument (device and prosthesis) of at least 20,000 Thai Baht (THB); (5) surgical and anesthesia costs at least 5,000 THB; and (6) patients aged 18 years and older. The study specifically analyzed the costs and influencing factors for patients undergoing uncomplicated knee replacement (DRG 08030 knee replacement without significant cost and clinical complexity (,wo sig CCC). Additionally, the cost-to-charge ratio and hospital cost recovery rate were assessed. The statistical methods used were descriptive statistics and multiple regression analysis. 

The results showed that 5,621 admission from 34 hospitals who underwent total knee replacement (TKR) met the selection criteria. The majority were female (4,541 admission, 80.8%) with a mean age of 65.3 years (SD 7.2). Three quarters (4,197 or 74.7%) were covered by the universal coverage scheme. A total of 5,395 admission (96.0%) were DRG 08030 (knee replacement wo sig CCC). The average hospital cost per admission was 80,434 THB (SD 23,389), with a median of 76,596. Patients aged over 65 years incurred the highest costs, averaging 81,284 THB per admission (SD 24,484), with a median of 77,077. General hospitals and regional hospitals with 500–699 beds had the highest average cost of 88,117 THB (SD 27,204), with a median of 80,259. This was followed by regional hospitals with 700–1,000 beds, where the average cost per admission was 85,616 THB (SD 28,417), with a median of 25,243. Patients under the social security scheme (SS) had the highest average cost per admission at 83,140 THB (SD 26,302), with a median of 78,657. This was followed by patients under the local administration officer scheme (LA) with an average cost of 82,117 THB per admission (SD 24,820) and a median of 75,944 THB. Patients covered by the civil servant medical benefit scheme (CS) had an average cost of 80,933 THB per admission (SD 24,175) and a median of 77,055, while those under the universal coverage scheme (UC) had an average cost of 80,561 THB per admission (SD 24,102), with a median of 76,263. Regression analysis of factors influencing costs showed that the length of hospital stays, hospital size, insurance scheme, and prosthetic material costs significantly explained 86.12% of the variability in total knee replacement (TKR) costs per admission (Adjusted R-square = 0.86, p < 0.001). Additionally, larger hospitals with 300 or more beds had lower costs compared to smaller hospitals. Overall, the cost-to-charge ratio (RCC) for total knee replacement (TKR) was 0.81, with a cost recovery rate of 98.2%. The CS schemes had the highest cost recovery rate at 118.8%. The SS had a cost recovery rate of 104.3%, while the UC had the lowest rate at 92.9%. Regional hospitals with more than 1,000 beds had the highest cost recovery rate at 123.8%, followed by general hospitals with 300–499 beds at 97.9% and general hospitals with 60–299 beds at 93.8%

In summary, the cost of TKR was relatively high and was influenced by length of hospital stay, hospital group, health insurance scheme, and instrument costs. Hospitals achieved an almost full cost recovery rate. The findings from this study could be used to improve the efficiency of resource allocation in hospitals. At the same time, policymakers could utilize this information to plan resource distribution for the prevention and treatment of rising osteoarthritis. However, caution should be exercised when applying these findings, as they were based on data from a limited number of hospitals and better hospital coverage should be the aim. 

Keywords: hospital cost, total knee replacement, cost recovery rate

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