# Assessing the value for money of a registry: an exploratory analysis of the Dutch Arthroplasty Register

## TL;DR

This study explores whether arthroplasty registries are worth the cost by analyzing the Dutch Arthroplasty Register's expenses and potential savings from preventing joint revision surgeries.

## Contribution

The study introduces a novel approach to assess the cost-effectiveness of arthroplasty registries by linking registration costs to revision prevention.

## Key findings

- Preventing 1–2 revisions per hospital over 30 years could offset the registry's costs.
- Outlier hospitals improving their revision rates could prevent hundreds of revisions.
- Recent improvements in revision rates suggest potential cost savings.

## Abstract

It is unclear whether arthroplasty registries provide value for money. We aimed to provide insight into this value for money by relating the costs of the Dutch Arthroplasty Register (LROI) to potential benefits from preventing revisions.

We included all primary total hip (n = 276,252) and knee (n = 217,901) arthroplasties (THA/TKA), and all first revisions of these THAs (n = 8,604) and TKAs (n = 8,745) from the LROI between 2014 and 2022. Threshold analyses estimated at which number of prevented revisions the benefits (i.e., savings and increased quality of life) outweighed the LROI costs. Scenario analyses explored whether the required revision reductions were feasible, including the minimum revision reduction required per hospital, revision reduction at outlier hospitals only, and the potential impact of temporal changes in national 1-year revision rates.

The LROI costs were €5,697,120 for THA registration and €4,532,920 for TKA registration between 2014 and 2022. Preventing 119 to 145 THA revisions and 106 to 134 TKA revisions would be required in the current patient population over 30 years for the benefits to outweigh these LROI costs between 2014 and 2022, depending on revision costs. Each Dutch hospital should prevent 1.2 to 1.5 THA revisions and 1.1 to 1.3 TKA revisions to achieve the required revision reduction. Moreover, 306 THA revisions and 140 TKA revisions could be prevented if outlier hospitals improved their 1-year overall revision rate to the upper 99% control limit. Compared with the calendar years showing the highest revision rates, applying 2022 1-year revision rates to 2023 procedure volumes resulted in reductions of 1.5% for THAs and 0.3% for TKAs.

Preventing approximately 1–2 revisions per hospital over 30 years would offset the LROI’s registration costs. Although causality cannot be established, these findings suggest that national arthroplasty registries may provide good value for money when actively used to reduce revision rates.