Abstract
Purpose The aim was to assess the cost-effectiveness of robotic arm-assisted total hip arthroplasty (rTHA) compared with manual total hip arthroplasty (mTHA) and to assess the influence of annual volume on the relative cost-effectiveness of rTHA. Methods A database of both rTHA (n = 48 performed in a private centre) and mTHA (n = 512 performed in the National Health Service) was used. Patient demographics, preoperative Oxford hip score, forgotten joint score, EuroQol 5-dimensional 3-level (EQ-5D), and postoperative EQ-5D were recorded. Two models for incremental cost-effectiveness ratios using cost per quality-adjusted life year (QALY) for rTHA were calculated based on a unit performing 100 rTHAs per year: 10-year follow-up and a lifetime time horizon (remaining life expectancy of a 69-year-old patient). Results When adjusting for confounding factors, rTHA was independently associated with a 0.091 (p=0.029) greater improvement in the EQ-5D compared to mTHA. This resulted in a 10-year time horizon cost per QALY for rTHA of £1,910 relative to mTHA, which increased to £2,349 per QALY when discounted (5%/year). When using the 10-year time horizon cost per QALY was approximately £3,000 for a centre undertaking 50 rTHAs per year and decreased to £1,000 for centre undertaking 200 rTHAs per year. Using a lifetime horizon, the incremental unadjusted cost per QALY gained was £980 and £1432 when discounted (5%/year) for rTHA compared with mTHA. Conclusions Despite the increased cost associated with rTHA, it was a cost-effective intervention relative to mTHA due to the associated greater health-related quality of health gain, according to the EQ-5D outcome measure.
Highlights
Despite total hip arthroplasty (THA) being declared the operation of the last century, offering good functional outcome and high satisfaction rates, robotic arm-assisted surgery has the potential to enhance the outcome further. [1, 2] e MAKO Robotic Arm Interactive Orthopaedic (RIO) system (Stryker; Kalamazoo, MI, USA) is a semiactive system and was first used to perform robotic arm-assisted total hip arthroplasty (rTHA) in 2010 with subsequent FDA approval in 2015. [2] ere is a growing body of evidence that demonstrates that rTHA improves component positioning accuracy when compared to manual (m)THA [3] and has been demonstrated to offer greater functional benefit over manual total hip arthroplasty (mTHA) [4, 5]
There were no differences in the joint-specific (OHS and forgotten joint score (FJS)) scores between the two groups (Table 1). e rTHA group had significantly better mean postoperative EuroQol 5-dimensional 3-level (EQ-5D) utility compared with the mTHA group, but the overall unadjusted change/improvement was not significantly different between the groups (Table 2). e factors associated with change in the EQ-5D following surgery were the preoperative Oxford hip score (OHS), FJS, EQ-5D, and EQVAS scores (Table 3), with greater scores being related to a smaller change in the EQ-5D utility
Despite the increased cost associated with rTHA, the lifetime cost per quality-adjusted life year (QALY) for rTHA was £980, or £1,432 when discounted, compared with mTHA, which was driven by the relative increased healthrelated quality-of-life gain associated with rTHA
Summary
Despite total hip arthroplasty (THA) being declared the operation of the last century, offering good functional outcome and high satisfaction rates, robotic arm-assisted surgery has the potential to enhance the outcome further. [1, 2] e MAKO Robotic Arm Interactive Orthopaedic (RIO) system (Stryker; Kalamazoo, MI, USA) is a semiactive system (surgeon required) and was first used to perform rTHA in 2010 with subsequent FDA approval in 2015. [2] ere is a growing body of evidence that demonstrates that rTHA improves component positioning accuracy when compared to manual (m)THA [3] and has been demonstrated to offer greater functional benefit over mTHA [4, 5]. [2] ere is a growing body of evidence that demonstrates that rTHA improves component positioning accuracy when compared to manual (m)THA [3] and has been demonstrated to offer greater functional benefit over mTHA [4, 5] Whether this improvement in functional outcome is cost-effective is not clear [3, 6]. Advances in Orthopedics study (using published utilities, mortality, and revisions rates) using American healthcare costs and demonstrated rTHA to be more cost-effective than mTHA. They did not account for the increased costs of the robot or the costs associated with preoperative imaging and intraoperative consumables, which are required relative to mTHA. It is not clear whether rTHA is associated with an increased health-related quality of life compared with mTHA with only Domb et al [11] demonstrating a significant improvement in physical health using the 12-Item Short Form (SF)-12 score in contrast to Bukowski et al [12]
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