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Economic Evaluation of Web-Based Compared with In-Person Follow-up After Total Joint Arthroplasty

Marsh, Jacquelyn PhD; Hoch, Jeffrey S. PhD; Bryant, Dianne PhD; MacDonald, Steven J. MD, FRCSC; Naudie, Douglas MD, FRCSC; McCalden, Richard MD, FRCSC; Howard, James MD, FRCSC; Bourne, Robert MD, FRCSC; McAuley, James MD, FRCSC

Journal of Bone & Joint Surgery - American Volume: 19 November 2014 - Volume 96 - Issue 22 - p 1910–1916
doi: 10.2106/JBJS.M.01558
Scientific Articles

Background: We previously demonstrated the feasibility and clinical effectiveness of a web-based assessment following total hip or total knee arthroplasty. The purpose of the present study was to conduct an economic evaluation to compare a web-based assessment with in-person follow-up.

Methods: Patients who had undergone total joint arthroplasty at least twelve months previously were randomized to complete a web-based follow-up or visit the clinic for the usual follow-up. We recorded travel costs and time associated with each option. We followed patients for one year after the web-based or in-person follow-up evaluation and documented any resource use related to the joint arthroplasty. We conducted cost analyses from the health-care payer (Ontario Ministry of Health and Long-Term Care) and societal perspectives. All costs are presented in 2012 Canadian dollars.

Results: A total of 229 patients (118 in the web-based group, 111 in the usual-care group) completed the study. The mean cost of the assessment from the societal perspective was $98 per patient for the web-based assessment and $162 per patient for the usual method of in-person follow-up. The cost for the web-based assessment was significantly lower from the societal perspective (mean difference, $−64; 95% confidence interval [CI], $−79 to $−48; p < 0.01) and also from the health-care payer perspective (mean difference, $−27; 95% CI, $−29 to $−25; p < 0.01).

Conclusions: The web-based follow-up assessment had a lower cost per patient compared with in-person follow-up from both societal and health-care payer perspectives.

1Faculty of Health Sciences, Elborn College, The University of Western Ontario, 1201 Western Road, London, ON N6G 1H1, Canada. E-mail address for J. Marsh: E-mail address for D. Bryant:

2Centre for Excellence in Economic Analysis and Research, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada. E-mail address:

3London Health Sciences Centre, University Hospital, 339 Windermere Road, London, ON N6A 5A5, Canada. E-mail address for S.J. MacDonald: E-mail address for D. Naudie: E-mail address for R. McCalden: E-mail address for J. Howard: E-mail address for R. Bourne: E-mail address for J. McAuley:

Copyright 2014 by The Journal of Bone and Joint Surgery, Incorporated
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