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Robotic Arm-assisted Total Hip Arthroplasty is More Cost-Effective Than Manual Total Hip Arthroplasty: A Markov Model
David R Maldonado1, Cammille C Go, Cynthia Kyin
1From American Hip Institute, Des Plaines, IL (Dr. Lall and Dr. Domb), American Hip Institute Research Foundation, Hoffman Estates, IL (Dr. Maldonado, Ms. Kyin, Dr. Rosinsky, Dr. Shapira, Dr. Lall, and Dr. Domb), AMITA Health St. Alexius Medical Center, Hoffman Estates, IL (Dr. Lall and Dr. Domb), and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Ms. Go).
Background:
Total hip arthroplasty (THA) is the benchmark surgical treatment of advanced and symptomatic hip osteoarthritis. Preliminary evidence suggests that the robotic arm-assisted (RAA) technology yields more accurate and reproducible acetabular cup placement, which may improve survival rate and clinical results, but economic considerations are less well-defined. The purpose of this study was to compare the cost effectiveness of the RAA THA with manual THA (mTHA) modalities, considering direct medical costs and utilities from a payer's perspective.
Methods:
A Markov model was constructed to analyze two potential interventions for hip osteoarthritis and degenerative joint disorder: RAA THA and mTHA. Potential outcomes of THA were categorized into the transition states: infection, dislocation, no major complications, or revision. Cumulative costs and utilities were assessed using a cycle length of 1 year over a time horizon of 5 years.
Results:
RAA THA cohort was cost effective relative to mTHA cohort for cumulative Medicare and cumulative private payer insurance costs over the 5-year period. RAA THA cost saving had an average differential of $945 for Medicare and $1,810 for private insurance relative to mTHA while generating slightly more utility (0.04 quality-adjusted life year). The preferred treatment was sensitive to the utilities generated by successful RAA THA and mTHA. Microsimulations indicated that RAA THA was cost effective in 99.4% of cases.
Conclusions:
In the Medicare and private payer scenarios, RAA THA is more cost effective than conventional mTHA when considering direct medical costs from a payer's perspective.
Level Of Evidence:
Economic Level III. Computer simulation model (Markov model).
