Social Security Agency Research Articles

Implications of Social Inequality for Soldiers in Health Services of the Indonesian National Armed Forces Managed by the Social Security Agency

This scientific journal research analyzes Law No. 24 of 2011 on health services for the Indonesian National Armed Forces (TNI) sector along with their families included in the national health insurance managed by the Healthcare and Social Security Agency (BPJS) and its implementation regulated in the Presidential Regulation and Health Minister Regulation. However, the implementation of the BPJS health insurance at the TNI institutions does not show effective results, and it tends to decline. Therefore, it is necessary to interpret various factual factors affecting the success of the implementation process of health service delivery policies, which will be useful for finding synergies in the implementation of health services in the TNI. This research on the implementation of policies in the TNI health services was a scientific activity prepared using certain types and strategies and at the same time viewed from certain aspects which had several types and strategies. Therefore, this research used the descriptive qualitative method. Six factors should be interpreted to know the implementation of the TNI health service policy under Law No. 24 of 2011, namely; 1) policy standards and objectives, 2) resources, 3) characteristics of the implementing organization, 4) attitudes of the implementers, 5) communication among organizations related to implementation activities, 6) social, economic and political environments. All these factors synergize with each other and affect health services to TNI, which are administered by BPJS.

Perlindungan Hukum Peserta Program Jaminan Hari Tua pada Badan Penyelenggara Jaminan Sosial Ketenagakerjaan atas Penunggakan Pembayaran Iuran oleh Pemberi Kerja

The research objectives were to analyze the legal protection of participants of the old age guarantee program as well as the threat of sanctions for companies that delinquent payment of Social Security Agency for Employe (BPJS Employment) dues. The research used a juridical-sociological approach with a type of sociolegal research. Data sources in the form of primary, secondary, and tertiary data were analyzed qualitatively. Legal protection of participants of the old age guarantee program consisted of preventive legal protection, namely through Government Regulation Number 60 of 2015, and repressive legal protection based on internal Standard Operating Procedure (SOP) from BPJS Employment provided if the company in question delinquent dues payment. The threat of sanctions for companies that delinquent payment of BPJS Employment dues was in the form of administrative sanctions, although in practice the sanctions were considered ineffective to be applied.

The National Health Insurance System of Indonesia and primary care physicians' job satisfaction: a prospective qualitative study.

The implementation of the National Health Insurance System (NHIS) in Indonesia has been changing the primary care physician (PCP) work condition and their job satisfaction. This research aimed to explore the reasons behind PCPs' satisfaction and dissatisfaction with job satisfaction's aspect under the NHIS reform. We conducted an exploratory qualitative study within two areas in Central Java, Indonesia, using semi-structured in-depth interviews with 34 PCPs and 19 triangulation sources. We conducted both inductive and deductive analyses by the NVivo 11. Most PCPs felt dissatisfied with the following aspects of the NHIS: referral system, NHIS health services standard, NHIS programmes, performance evaluation and pay-for-performance, relationship with patient and workloads. PCPs felt constrained with the referral regulation and non-specialist diagnoses, which led to dissatisfaction with performance evaluation and the pay-for-performance implementation. Furthermore, an increase in workload and conflict with patients resulted from patients' misunderstanding the NHIS health service procedures. However, PCPs felt satisfied with the chronic disease management programme and patients' appreciation. This study presents the reasons behind PCPs' satisfaction and dissatisfaction with job satisfaction's aspect under the NHIS reform. There is a need for additional discussion among all stakeholders (Ministry of Health, Social Security Agency for Health/SSAH, primary health care and physician's professional organizations about the non-specialist diagnoses list, performance evaluation and pay-for-performance). The government and SSAH need to improve the communication and socialization of the NHIS procedures/regulations.

Implementasi Undang-Undang Republik Indonesia Nomor 24 Tahun 2011 Tentang Badan Penyelenggara Jaminan Sosial pada Pasien Rawat Inap di Rumah Sakit Bhayangkara Palembang

The implementation of social security is regulated in Law Number 24 of 2011 on Healthcare and Social Security Agency (hereinafter abbreviated BPJS). Although it has been implemented quite well, there are still things that have not been done optimally. This study aims to determine how the implementation of Law Number 24 of 2011 at Bhayangkara Hospital, Palembang. This research method is qualitative, primary data were collected through observation and interviews. Parameters measured based on the policy implementation model developed by Edward III include communication, resources, disposition, and organizational structure. The results showed that the communication was good, both from the socialization and the existence of supporting tools for notification posters related to BPJS. Resources include friendly employee attitudes and courtesy, the services provided are satisfying and the flow is easy to follow. In the aspect of disposition, all implementers at Bhayangkara Hospital are honest, committed, and democratic. Some of the problems that exist are the lack of human resources at Bhayangkara Hospital compared to the number of patients, lack of medical equipment, the BPJS claim process is still inefficient, and the existence of arrears in payments from the BPJS.

HUBUNGAN FAKTOR-FAKTOR YANG MEMPENGARUHI PENGETAHUAN PESERTA BADAN PENYELENGGARA JAMINAN SOSIAL (BPJS) DENGAN ALUR PROSEDUR PELAYANAN PASIEN RAWAT JALAN

Abstract The flow of service procedures is the Rules or systems there are made to serve or meet the needs of others to get care about health without the need for lodging. Health services had a plot and procedures that must be known and obeyed by BPJS patients. The completeness of administrative requirements will affect the rapid or delayed process of health services. The purpose of this study is to determine the relationship of Factors Affecting the Knowledge of Participants Social Security Agency (BPJS with the Procedure of patient services In Grandmed Hospital Lubuk Pakam 2017. This research is an analytic research. This type of research used an observational design with Cross sectional approach. The population in this study were all outpatients using BPJS health at Grandmed Hospital Lubuk Pakam Hospital were the outpatient BPJS hospital patients at Grandmed Hospital lubuk pakam. The Sample in this research was partial of BPJS patient of outpatient of 30 people. Sampling in this research was done by using technique of non probability sampling, that was Quota sampling. There are no age correlation with service procedure flow with value (p) = 0,696> 0,05. There are an information relation with service procedure flow with value (p) = 0,018 <0,05. There are an educational relationship with the service procedure flow with the value (p) = 0.005 <0.05. There are no work relationship with the service procedure flow with the value (p) = 0.385> 0.05. It are expected that the health BPJS participants should be more active in finding information about the service procedure flow applied by the hospital Grandmed hospital so that the BPJS health participants who will conduct outpatient treatment to made the registration process faster.

Is the \u201cBrainwork Intervention\u201d effective in reducing sick leave for non-permanent workers with psychological problems? Results of a controlled clinical trial

BackgroundBoth the presence of psychological problems and the absence of an employment contract are related to long-term sickness absence, prolonged work disability and unemployment. Studies researching the effectiveness of return-to-work interventions on these non-permanent workers, including unemployed and temporary agency workers and workers with an expired fixed-term contract, are lagging behind. Therefore, a return-to-work intervention called “Brainwork” was developed. The aim of this study was to assess the effectiveness of the ‘Brainwork Intervention’ in reducing the duration of sick leave compared to usual care over a 12-month follow-up.MethodsIn a multicenter controlled clinical trial, using a quasi-randomization procedure, we compared the Brainwork Intervention (n = 164) to usual care (n = 156). The primary outcome was the duration of sick leave. Secondary outcomes were the duration of sick leave starting from Social Security Agency transfer; the proportion of workers returned to work; the number of hours of paid employment during the follow-up period; the degree of worker participation; the level of psychological complaints; and the self-efficacy for return to work. Protocol adherence (Brainwork Intervention) was considered sufficient when at least three of the five protocol steps were followed. Cox regressions, linear and ordinal regression, and Mixed Model analyses were performed.ResultsAll 320 participants were analyzed. The Brainwork Intervention resulted in a non-significant reduction of the duration of sick leave compared to usual care (269 days versus 296 days; HR = 1.29; 95% CI 0.94–1.76; p = 0.11). For those working (46%) during the 12-month follow-up, the mean number of hours of paid employment was non-significantly higher in the usual care group (682 h versus 493 h; p = 0.053). No significant differences were found for other secondary outcomes. Protocol adherence was 10%.ConclusionsThe Brainwork Intervention as performed with a low protocol adherence did not result in a significant reduction of the duration of sick leave compared to usual care. It remains unclear what the results would have been if the Brainwork Intervention had been executed according to protocol.Trial registrationThe Netherlands Trial Register (NTR); NTR3976 (old registration number NTR4190). Registered September 27th 2013.

Effect of Rape on Physical and Psychological Aspects of Girl Child in Northern Nigeria

Rape is considered as a heartrending moment in a woman’s or girl’s life, it is reality but remain hidden to appropriate authority due to certain distress associated with stigma against the survivor, fear of victimization, cultural barrier, religious sentiments, shame influential, and lack of cognizance on human right. Rape is simply when sexual intercourse occur without ones consent (not willing) or force a person to have sexual intercourse against his/her will, it happen when someone is intoxicated from alcohol or drugs and sometimes for ritual purpose. It can be through vagina, anus or mouth. In northern Nigeria, rape is defined under section 282 of the panel code as. (a) Any act of rape against her will, (b) obtained by putting her fear, threats or death, (iii) with her consent when the man knows that he is not her husband and that her concern is given because she believes that he is the man who to whom she is or believe herself to be lawfully married to, (iv) with or without her consent when she is under fourteen years of age. The main objective of this paper is to examine the following. Why do men rape? How does rape harm victims psychologically? , What should I do if I have been raped? How can I protect myself from rape? What is the best way to prevent STD. Rape as felony, is among the most serious crime a person can commit, men as well as women and children can be raped. This paper will seek an answer to the above questions and provide some recommendations which will be of great importance to social agencies, survivors, parents and security agencies.

Cost-Effectiveness Analysis of Type 2 Diabetes Mellitus (T2DM) Treatment in Patients with Complications of Kidney and Peripheral Vascular Diseases in Indonesia.

Type 2 diabetes mellitus (T2DM) is a chronic disease with high-cost treatment. This study aimed to analyze the cost-effectiveness of T2DM treatment in hospitalized patients with complications of kidney and peripheral vascular disease (PVD) in Indonesia by focusing on patients of Health Social Security Agency (BPJS Kesehatan). An observational study was applied by collecting data retrospectively from patients’ medical record at the biggest public hospital in West Java Province, Indonesia. Two perspectives of payer and healthcare provider were applied to estimate the treatment cost. We considered following inclusion criteria: (i) Hospitalized T2DM patients without complication, with complications of kidney and PVD during 2014–2017; (ii) member of BPJS Kesehatan; (iii) >18 years old patients; and (iv) patients with complete medical record data. The results showed that the majority patients were female (56.72%), 45–64 years old (69.40%), and had a length of stay at 4–10 days (54.48%). The greatest contributions in the total treatment cost were found to be hospital room, medical services and medicines for the treatment of T2DM without complications, with complications of kidney and PVD, respectively. From the perspective of payer, the incremental cost-effectiveness ratios (ICERs) of T2DM treatment with complications of kidney and PVD would be IDR 215,723 and IDR 234,591 per 1 mg/dL blood glucose reduction, respectively. From the perspective of healthcare provider, the ICERs of T2DM treatment with complications of kidney and PVD would be IDR 166,289 and IDR 681,853 per 1 mg/dL blood glucose reduction in both perspectives (1 US$ = IDR 13,451). In a comparison with T2DM without complication, reducing 1 mg/dL blood glucose in T2DM treatment with complication of PVD would require higher cost than in T2DM treatment with complication of kidney from both perspectives.

Est-ce que les implants sur mesure par impression 3D ont une valeur suffisante pour justifier leur surcoût ? Étude médico-économique comparant un implant poreux obtenu par impression 3D et son alternative proche pour le traitement des pertes de substances acétabulaires Paprosky 3B

Total hip arthroplasty (THA) is a common operation for patients suffering from hip arthrosis. It has been proven effective in improving quality of life while being cost-effective. Meanwhile, the number of revision hip arthroplasties is growing and those may require bone reconstruction and are potential indications for 3D custom implants. In these specific indications, medical 3D-printing has grown over the years and the use of 3D-printed implants has become more frequent. To date, the cost-effectiveness of 3D-printed implants for acetabular revision THA has not been evaluated. Therefore we performed a health economic analysis to: 1) analyse the cost-effectiveness of the aMace implant compared to its closest alternative on the market; 2) have a better insight into Belgian costs of revision hip arthroplasties and 3) estimate the budget impact in Belgium. 3D-printed acetabular implants provide good value-for-health in Paprosky type 3B defects in a Belgian setting. Custom Three-flanged Acetabular Components (CTAC) were compared to a 3D-printed implant (aMace) by means of a Markov model with four states (successful, re-revision, resection and dead). The cycle length was set at 6 months with a 10-year time horizon. Data was obtained through systematic literature search and provided by a large social security agency. The analysis was performed from a societal perspective. All amounts are displayed in 2019 euros. Discount rates were applied for future cost (3 %) and QALY (1.5 %) estimates. Revision hip arthroplasty has an average societal cost of €9950 without implant. Based on the outcomes of our model, aMace provides an excellent value for money compared to CTAC. The Incremental Cost-Effectiveness Ratio (ICER) was negative for all age groups. The base case of a 65-year-old person, showed a QALY gain of 0.05 with a cost reduction of €1265 compared to CTAC. The advantage of using aMace was found to be greater if a patient is younger. The re-revision rates of both CTAC and aMace and the utility of successful revision have the highest impact on costs and effects. A Monte Carlo simulation showed aMace to be a cost-effective strategy in 90 % of simulations for younger patients and in 88 % of simulations for patients above 85 years old. In Belgium, it would imply a cost reduction of €20500 on an annual basis. Based on the findings of this model, the new 3D-printed aMace implant has the potential to bring an excellent value for money when used in revision arthroplasty of Paprosky type 3B acetabular defects. For all patients, aMace resulted in a dominant, cost-saving strategy in Belgium compared to CTAC. III, comparative medico economical diagnostic tool.

Obowiązek zgłoszenia umowy o dzieło do ZUS – usprawnienie systemu kontroli w świetle konstytucyjnych zasad równości, proporcjonalności i autonomii informacyjnej

Obligation to notify Social Security Agency about a specific work contract – improvement of the control system in the light of constitutional principles of equality, proportionality and information autonomy The purpose of the paper is to analyze obligation to notify Social Security Agency about concluded specific work contracts, which was introduced as of 1 January 2021 in the social security system act. Firstly, the way in which the new obligation was introduced raises significant doubts. Under the guise of anti-crisis measures, a new obligation has been introduced in the Anti-Crisis Shield, which has little to do with its purpose. Secondly, the prima facie technical obligation also raises practical doubts, but more importantly, it prompts questions about its compliance with the constitutional principles of equality, proportionality and information autonomy. Fulfillment of the obligation results in transfer to the Social Security Agency of significant data on legal relationship that are – as a rule – indifferent from the perspective of the social security system, the scope of which is not determined by a statute, but by a sub-statutory act.

Adoption of e-payment system to support health social security agency

The development of the existing information technology era has helped the performance of BPJS more and more. The application of information technology in the work environment includes meeting the efficiency level of time and cost. The use of the internet also makes it easier for BPJS to access their services to the public and the search for new members is made easier. The world of ICT does provide a big role in society. In Indonesia itself, the prospect of ICT in future life has provided a lot of welfare for the people of Indonesia. This research was conducted in Indonesia, the sampling in this study was conducted in Jakarta. The results of research conducted showed that all hypotheses proposed in this study were accepted, especially the biggest influence was found on the attitude variable towards intention in the use of the BPJS e-payment system in Indonesia. Electronic Payment System (EPS) BPJS strives to create a social security system that is transparent and accountable to BPJS Employment participants.

ANALYSIS OF THE EFFECT OF OCCUPATIONAL SAFETY AND HEALTH ON EMPLOYEE PERFORMANCE OF PT. WIJAYA KARYA (PERSERO) TBK. AT THE NAYUMI SAM TOWER MALANG PROJECT

Human resources is one of the factors that affect production in a company, Because without human company could not go on, In fact it is now up to the present time the individual human being at main asset an enterprise in administered a set of production activities, This was because human beings have thought and your moral understanding, a feeling, energy, the level of knowledge, and creativity to accomplish a purpose a public social security agency. Maximum performance can be influenced by the work safety and health.
 This study attempts to know how big the influence of work safety and health on performance employees on PT. Wijaya Karya Nayumi Sam Tower Malang Project. The research was conducted between January 2018 and up to May 2018. Methods used is the quantitative method, technique data collection used is a study literature and spreading the questionnaire shown to an employee on PT. Wijaya Karya Nayumi Sam Tower Malang Project As many as 65 people. Sample selection in a non probability sampling techniques saturated sample. A method of analysis of data used was a validity test, reliability test, normality test, multiple linear regression, t test and f test and the coefficients of determined.
 The research results show that simultaneously variable work safety and health simultaneously influences employee performance at Nayumi Sam Tower Malang project As much as 50.4% while the rest is influenced by the other factors that not investigated in this study. Key Word: Safety, health and employee performance

PENGARUH ETHICAL LEADERSHIP TERHADAP AFFECTIVE COMMITMENT YANG DIMEDIASI OLEH ETHICAL CLIMATE DENGAN GENDER SEBAGAI PEMBEDA PADA KARYAWAN KANTOR PUSAT BPJS KETENAGAKERJAAN

This research aims to look at the effect of Ethical Leadership on Affective Commitments mediated by Ethical Climate. This research was conducted at the Head Office of the Manpower Social Security Agency (BPJS). Some specific divisions within the BPJS Employment Headquarters. The questionnaire was collected by 100 respondents from a population of 483 employees using the Convenience Sampling method. Male respondents numbered 56 people and female respondents numbered 44 people from various divisions. Data processing was performed using SPSS version 22 software and Hayes PROCESS version 3 macro. The results of this study on male respondents indicate that the Ethical Climate variable can mediate the effect of Ethical Leadership on Affective Commitment. Whereas the female respondents Ethical Climate variable did not mediate the effect of Ethical Leadership on Affective Commitment.

ANALISIS FAKTOR-FAKTOR YANG MEMPENGARUHI KEPESERTAAN PROGRAM JAMINAN KESEHATAN NASIONAL PADA PEKERJA INFORMAL PERKOTAAN

Jaminan Kesehatan Nasional (JKN) lahir sebagai amanat UU No. 40 Tahun 2004 tentang Sistem Jaminan Sosial Nasional (SJSN) serta UU No. 24 Tahun 2011 tentang Badan Penyelenggara Jaminan Sosial Nasional yang menunjuk PT. Askes (Persero), selanjutnya disebut BPJS Kesehatan, kemudian ditindaklanjuti dengan Perpres No. 12 Tahun 2013 dan Perpres No. 111 Tahun 2013 telah mengamanatkan bahwa seluruh warga negara Indonesia harus sudah tergabung dalam program JKN selambat-lambatnya tanggal 1 Januari 2019. Tantangannya adalah bagaimana membuat orang-orang yang tidak terlindungi bersedia menjadi peserta JKN dalam target waktu yang ditentukan. Studi ini menguji probabilitas seorang pekerja sektor informal perkotaan sebagai target utama penduduk yang tidak terlindungi asuransi untuk menjadi peserta JKN berdasarkan sepuluh variabel bebas yaitu stimulus harga, stimulus diskon, stimulus periode pembayaran, precautionary motive, access motive dalam membeli asuransi, pengetahuan tentang financial planning yang meliputi manajemen risiko, manajemen menabung, perencanaan hari tua, perencanaan waris, dan manajemen cash flow rumah tangga. Penelitian dilakukan melalui wawancara langsung di wilayah Jabodetabek terhadap 150 pekerja sektor informal. Hasil penelitian mengindikasikan empat variabel bebas memiliki pengaruh yang signifikan terhadap probabilitas seseorang menjadi peserta JKN yaitu stimulus diskon, access motive dalam membeli asuransi, manajemen cash flow dan perencanaan harta waris.

Haemolymphatic cancer among children in Sardinia, Italy: 1974–2003 incidence

ObjectivesTo explore the time trend and geographical distribution of childhood leukaemia incidence over the territory of the Italian region of Sardinia.SettingAll hospitals departments, diagnostic centres and social security agencies in...

Investigating the entrepreneurial intentions of social grant recipients in the cities of Johannesburg and Tshwane

Purpose: The primary aim of this study was to investigate the entrepreneurial intentions of social grant recipients in the cities of Johannesburg and Tshwane. This study further investigated the extent to which social grants influence the entrepreneurial behaviour of social grant recipients. Design/methodology/approach: A descriptive cross-sectional survey design was adopted. Primary data were collected using a structured questionnaire randomly targeting social grant recipients at various SAPO branches and SASSA pay-points. To test the hypotheses, the data collected from 401 respondents in the cities of Johannesburg and Tshwane was analysed on the SPSS statistics software (version 25). Findings/results: It was discovered that most of the respondents intended to start a business in the absence of a social grant income. Although SASSA grant holders indicated that they intended to start businesses, 70% of the respondents had no knowledge of any public or private business support initiatives and had not been to any entrepreneurial training sessions offered by the public or private sector. The respondents within the youth age group who indicated interest to start a business also expressed their desire for immediate gratification. Given that an entrepreneurial career requires a long-term vision, persistence and perseverance, this is indicative of a lack of entrepreneurial intensity. Practical implications: In order to increase social grant recipients’ entrepreneurial intentions and possibly reduce the number of youth social grant recipients currently in the system, government stakeholders should include the existing public and private entrepreneurship support initiatives within South African Social Security Agency (SASSA) policies. Originality/value: With the application of quantitative methodologies, this research contributes to an evidence-based debate on the extent to which social grants influence the entrepreneurial behaviour of social grant recipients within the Republic of South Africa.

ANALISIS KUALITAS PRODUK, KUALITAS PELAYANAN, KONDISI EMOSIONAL, PERSEPSI HARGA DAN BIAYA TERHADAP KEPUASAN PESERTA JKN-KIS PEKERJA PENERIMA UPAH BADAN USAHA SWASTA DI BPJS KESEHATAN CABANG SAMPIT KALIMANTAN TENGAH

This research was conducted to determine the effect of product quality, service quality, emotional conditions, price perceptions and costs on JKN-KIS participant registration satisfaction of workers receiving wages private businesses entity in Healthcare Social Security Agency, Sampit Branch, Central Borneo. This study uses questionnaire to 100 workers receiving wages private businesses entity. The results showed that variables of product quality, service quality and price perception has significant effect on satisfaction of JKN-KIS participants workers receiving wages private businesses entity. Meanwhile, emotional condition and cost variables hasn’t significant effect on satisfaction of JKN-KIS participants workers receiving wages from private businesses entity. Then, variables of product quality, service quality, emotional condition, perceived price and cost simultaneously has significant effect satisfaction of JKN-KIS participants workers receiving wages private businesses entity with calculated F value (4.082) > F table (2.310). Based on the results of study it’s also known that service quality is the most variable has significant effect on satisfaction of JKN-KIS participants workers receiving wages private businesses entity with value of Beta Coefficients 0.196.
 Keywords: JKN-KIS, product quality, service quality, emotional condition, price perception, cost, satisfaction

Co-experience, co-production and co-governance: an ecosystem approach to the analysis of value creation

This conceptual article explores the interplay between the participation of service users and third sector organisations and the related implications for value creation. It draws on public service logic, which uses value as a lens through which to view public service delivery and presents an ecosystem perspective to understand the interconnectivity and complexity of value creation. To illustrate the conceptual discussion, a contextual case study of the Scottish Social Security Agency and its services is presented. The analysis demonstrates that value creation is enabled and constrained by the congruence of goals among actors, the strategic direction and a participatory approach that combines ‘lived experience’ with expertise. The article adds to theory by understanding value creation from a systemic perspective, emphasising the interplay of participative processes and the wider societal context. For policy and practice, it suggests a change in how value is articulated, promised, created and measured.

Aktualisasi NDP dalam Mewujudkan Pelayanan Kesehatan yang Berkeadilan: Sebuah Literature Review

Indonesia is a country that aspires to social justice, strives to form a state structure that can improve the welfare of society in accordance with the mandate of the 1945 Constitution. Healthcare and Social Security Agency (BPJS) is the organizer of social security to realize welfare in the health sector. The concept of the National Health Insurance (JKN) is here to ensure that all Indonesian citizens get comprehensive, fair and equitable health services. The purpose of this study was to see the effect of patient participation status on the quality of health services as seen from the level of patient satisfaction. The existing patient participation status is BPJS patients and non-BPJS patients. This research was conducted using the literature study method with a collection of a number of scientific journals that are relevant to the problem being studied. The collected data were analyzed by means of qualitative descriptive analysis using three variables, namely patient participation status, patient satisfaction level and quality of health services. The results showed that there were differences in the quality of health services for BPJS and non-BPJS patients seen from the level of patient satisfaction.

Do custom 3D-printed revision acetabular implants provide enough value to justify the additional costs? The health-economic comparison of a new porous 3D-printed hip implant for revision arthroplasty of Paprosky type 3B acetabular defects and its closest alternative

PurposeTotal hip arthroplasty (THA) is a common operation for patients suffering from hip arthrosis. It has been proven effective in improving quality of life while being cost-effective. Meanwhile, the number of revision hip arthroplasty is growing and those may require bone reconstruction and are potential indications for 3D custom implants. In these specific indications, medical 3D-printing has grown over the years and the use of 3D-printed implants has become more frequent. To date, the cost-effectiveness of 3D-printed implants for acetabular revision THA has not been evaluated. Therefore we performed a health economic analysis to: (1) analyse the cost-effectiveness of the aMace implant compared to its closest alternative on the market, (2) have a better insight into Belgian costs of revision hip arthroplasties and (3) estimate the budget impact in Belgium. Hypothesis3D-printed acetabular implants provide good value-for-health in Paprosky type 3B defects in a Belgian setting. Material and methodsCustom Three-flanged Acetabular Components (CTAC) were compared to a 3D-printed implant (aMace) by means of a Markov model with four states (successful, re-revision, resection and dead). The cycle length was set at 6 months with a 10-year time horizon. Data was obtained through systematic literature search and provided by a large social security agency. The analysis was performed from a societal perspective. All amounts are displayed in 2019 euros. Discount rates were applied for future cost (3%) and QALY (1.5%) estimates. ResultsRevision hip arthroplasty has an average societal cost of €9950 without implant. Based on the outcomes of our model, aMace provides an excellent value for money compared to CTAC. The Incremental Cost-Effectiveness Ratio (ICER) was negative for all age groups. The base case of a 65 year old person, showed a QALY gain of 0.05 with a cost reduction of €1265 compared to CTAC. The advantage of using aMace was found to be greater if a patient is younger. The re-revision rates of both CTAC and aMace and the utility of successful revision have the highest impact on costs and effects. A Monte Carlo simulation showed aMace to be a cost-effective strategy in 90% of simulations for younger patients and in 88% of simulations for patients above 85 years old. In Belgium it would imply a cost reduction of €20500 on an annual basis. ConclusionsBased on the findings of this model, the new 3D-printed aMace implant has the potential to bring an excellent value for money when used in revision arthroplasty of Paprosky type 3B acetabular defects. For all patients, aMace resulted in a dominant, cost-saving strategy in Belgium compared to CTAC. Level of evidenceIII, comparative medico economical diagnostic tool.