Impacts of National Centralized Procurement on Willingness to Undergo Total Knee Arthroplasty in China: A Propensity Score Matching Analysis of 6,522 Patients

Abstract This study aimed to evaluate the changes in hospitalization costs of patients with advanced knee osteoarthritis under the centralized procurement policy of artificial joint prostheses in China and to determine whether these changes are related to patients' willingness to undergo surgery. A total of 7,189 patients with advanced knee osteoarthritis who visited the orthopedic outpatient department of Fuzhou Second General Hospital from May 2020 to April 2024 were included in this study. Patients were categorized into a control group according to the implementation timing of the national centralized procurement (NCP) and an NCP group. Data recorded included the patient's sex, age, date of treatment, decision to undergo surgical treatment, and for patients who did undergo surgical treatment, hospitalization costs and related composition, length of hospital stay, duration of surgery, and type of medical insurance. Of the 7,189 patients included, 3,427 were categorized into the control group and 3,762 patients into the NCP group. A total of 3,261 pairs of patients were successfully matched using the propensity score matching (PSM) method. Surgical intervention was received by 1,374 patients (42.1%) in the control group and 1,662 (51.0%) in the centralized procurement group. Pearson's chi-square test revealed a significant difference in surgical intention between the two groups (p < 0.001). Comparison of pre- and postcentralized procurement data for patients who underwent surgery showed a significant reduction in hospitalization and consumable costs after the introduction of centralized procurement (p < 0.001). The centralized procurement policy for artificial joint prostheses introduced in China has significantly reduced hospitalization costs for patients with advanced knee osteoarthritis and has increased their willingness to undergo surgery.