The Impact of Health Policy on Total Ankle Arthroplasty Prices in the United States.

BACKGROUND

Total ankle arthroplasty (TAA) is increasingly used due to advancements in surgical technology leading to promising results. Although TAA may have a higher upfront complication rate, its long-term benefits, including lower rates of adjacent joint arthritis and subsequent surgeries, may enhance its cost-effectiveness relative to ankle arthrodesis. Notable regional variability in TAA prices exists, influenced in part by state-level political dynamics and healthcare regulations. This study investigates how state-level political affiliation, certificate of need (CON) laws, and Medicaid expansion affect TAA pricing across the United States, with a specific focus on North Carolina.

METHODS

Data were sourced from the Turquoise Health Database, covering TAA prices since 2021. The unit of analysis was at the hospital level, with price defined as the negotiated hospital facility fee for TAA procedures (current procedural terminology code 27702), exclusive of physician fees. Multivariable regression analyses assessed relationships between TAA prices and factors, including CON regulations, Medicaid expansion, political affiliation, and socioeconomic variables like the area deprivation index. Political affiliation was assessed using both a composite score integrating five indicators of state political control and the Cook Partisan Voting Index for a more granular approach.

RESULTS

States with CON regulations showed lower TAA prices, with average savings of $1,650. Medicaid expansion correlated with higher prices, with an average increase of $1,690. The composite political score showed minimal effect, although the Cook Partisan Voting Index indicated higher prices in Republican-leaning states. In North Carolina, higher area deprivation index scores correlated with reduced TAA prices by $15,331.50, potentially due to competitive market pressures or reliance on government payers.

CONCLUSION

CON laws may reduce costs, whereas Medicaid expansion correlates with higher prices. Political affiliation shows minimal influence, with Republican affiliation weakly associated with higher prices. These findings provide insights for policymakers aiming to balance cost control and access to TAA.

LEVEL OF EVIDENCE: Level IV.