Can Robot-Assisted Unicompartmental Knee Arthroplasty Be Cost-Effective? A Markov Decision Analysis

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• 作者：Wayne E. Moschetti ; MD ; MSc^a ; Joseph F. Konopka ; MD ; MSc^b ; ; Harry E. Rubash ; MD^d ; James W. Genuario ; MD ; MS^c
• 关键词：unicompartmental arthroplasty ; robotic assistance ; cost ; economic analysis ; cost-effectiveness
• 刊名：The Journal of Arthroplasty
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：31
• 期：4
• 页码：759-765
• 全文大小：934 K

文摘

Unicompartmental knee arthroplasty (UKA) is a treatment option for single-compartment knee osteoarthritis. Robotic assistance may improve survival rates of UKA, but the cost-effectiveness of robot-assisted UKA is unknown. The purpose of this study was to delineate the revision rate, hospital volume, and robotic system costs for which this technology would be cost-effective.

Methods

We created a Markov decision analysis to evaluate the costs, outcomes, and incremental cost-effectiveness of robot-assisted UKA in 64-year-old patients with end-stage unicompartmental knee osteoarthritis.

Results

Robot-assisted UKA was more costly than traditional UKA, but offered a slightly better outcome with 0.06 additional quality-adjusted life-years at an incremental cost of $47,180 per quality-adjusted life-years, given a case volume of 100 cases annually. The system was cost-effective when case volume exceeded 94 cases per year, 2-year failure rates were below 1.2%, and total system costs were <$1.426 million.

Conclusion

Robot-assisted UKA is cost-effective compared with traditional UKA when annual case volume exceeds 94 cases per year. It is not cost-effective at low-volume or medium-volume arthroplasty centers.