Ontario hospitals’ purchasing practices for hip and knee prostheses: a survey

Objectives — To determine the makes, models and prices of the implants provided by Ontario hospitals for hip and knee replacements and the policies and procedures governing purchases.

Design — A questionnaire survey of hospitals with telephone follow-up.

Study Population — Seventy-nine public hospitals in Ontario in which 10 or more hip or knee replacements were carried out in the fiscal year 1993/94.

Survey Response — Seventy-six hospitals returned questionnaires (96% response rate), reporting on 4950 primary hip and 5107 primary knee implants. Sixty-two hospitals reported volumes and prices for 19 models used in 2961 hip implants. Information on price but not makes and models was available for 1989 hip implants. Model and price information was missing for 340 hip prostheses. Fifty-seven hospitals identified the models and prices for 3460 knee implants. Twenty-five hospitals provided prices but not specific models names for 1647 knee implants and hybrids.

Outcome Measure — The prices paid for prostheses.

Results — The average price of hip implants was Can$2141 (range from Can$650 to Can$3559). The average price for knee implants was Can$2412 (range from Can$1178 to Can$3777). The averages and ranges were about the same for specified and unspecified models and hybrids. The variations were unrelated to hospital policies about the numbers of procedures to be provided or the procedures for making purchases from suppliers.

Conclusions — Savings of Can$13.7 million could have been made in Ontario during the fiscal year 1993/94 had the lowest prices been paid for the implants. Although it may be neither desirable nor possible to use the least expensive model and price in every hospital, the potential for cost reductions in the purchase of implants is substantial.