Understanding economic analysis and cost–effectiveness of CT scan-guided, 3-dimensional, robotic-arm assisted lower extremity arthroplasty: a systematic review
This article has been corrected.
VIEW CORRECTIONPublication: Journal of Comparative Effectiveness Research
Abstract
Aim: The overall goal of this review was to examine the cost-utility of robotic-arm assisted surgery versus manual surgery. Methods: We performed a systematic review of all health economic studies that compared CT-based robotic-arm assisted unicompartmental knee arthroplasty, total knee arthroplasty and total hip arthroplasty with manual techniques. The papers selected focused on various cost-utility measures. In addition, where appropriate, secondary aims encompassed various clinical outcomes (e.g., readmissions, discharges to subacute care, etc.). Only articles directly comparing CT-based robotic-arm assisted joint arthroplasty with manual joint arthroplasty were included, for a resulting total of 21 reports. Results: Almost all twenty-one studies demonstrated a positive effect of CT scan-guided robotic-assisted joint arthroplasty on health economic outcomes. For studies reporting on 90-day episodes of costs, 10 out of 12 found lower costs in the robotic-arm assisted groups. Conclusion: Robotic-arm assisted joint arthroplasty patients had shorter lengths of stay and cost savings based on their 90-day episodes of care, among other metrics. Payors would likely benefit from encouraging the use of this CT-based robotic technology.
Tweetable abstract
A systematic review finds that robotic-arm assisted joint arthroplasty patients compared with manual techniques had shorter lengths of stay and cost savings based on their 90-day episodes of care, among other metrics.
Plain language summary
What is this article about?
We reviewed all health economic studies that examined partial and total knee replacements as well as hip replacements that were performed with the robotic-arm assistance and a preoperative computerized tomography scan compared with traditional techniques for performing these procedures. This led to an evaluation of 21 studies.
What were the results?
We found that the robotic-arm assisted joint replacement patients had shorter lengths of stay and cost savings. Almost every study in this review found economic advantages to using this new technology.
What do the results of the study mean?
Payors would likely benefit from encouraging the use of CT-based robotic technology.
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References
Papers of special note have been highlighted as: • of interest; •• of considerable interest
1.
Halawi MJ, Jongbloed W, Baron S, Savoy L, Williams VJ, Cote MP. Patient dissatisfaction after primary total joint arthroplasty: the patient perspective. J. Arthroplasty 34(6), 1093–1096 (2019).
2.
Elmallah RK, Chughtai M, Adib F, Bozic KJ, Kurtz SM, Mont MA. Determining health-related quality-of-life outcomes using the SF-6D following total hip arthroplasty. J. Bone Joint Surg. Am. 99(6), 494–498 (2017).
3.
Elmallah RK, Cherian JJ, Jauregui JJ, Bhowmik-Stoker M, Beaver WB, Mont MA. Determining health-related quality-of-life outcomes using the SF-6D preference-based measure in patients following total knee arthroplasty. J. Arthroplasty 30(7), 1150–1153 (2015).
4.
Mont MA, Banerjee S, Jauregui JJ, Cherian JJ, Kapadia BH. What outcome metrics do the various knee rating systems for assessment of outcomes following total knee arthroplasty measure? A systematic review of literature. Surg. Technol. Int. 26, 269–274 (2015).
5.
Domb BG, El Bitar YF, Sadik AY, Stake CE, Botser IB. Comparison of robotic-assisted and conventional acetabular cup placement in THA: a matched-pair controlled study. Clin. Orthop. Relat. Res. 472(1), 329–336 (2014).
6.
Samuel LT, Karnuta JM, Banerjee A et al. Robotic arm-assisted versus manual total knee arthroplasty: a propensity score-matched analysis. J. Knee Surg. 36(1), 105–114 (2023).
7.
Marchand KB, Moody R, Scholl LY et al. Results of robotic-assisted versus manual total knee arthroplasty at 2-year follow-up. J. Knee Surg. 36(2), 159–166 (2023).
• Comparison of 80 MTKAs and 80 RATKAs showing significantly better r-WOMAC pain, physical function and total scores for RATKA compared to MTKA.
8.
Marchand RC, Sodhi N, Bhowmik-Stoker M et al. Does the robotic arm and preoperative CT planning help with 3D intraoperative total knee arthroplasty planning? J. Knee Surg. 32(8), 742–749 (2019).
9.
Sherman WF, Wu VJ. Robotic surgery in total joint arthroplasty: a survey of the AAHKS membership to understand the utilization, motivations, and perceptions of total joint surgeons. J. Arthroplasty 35(12), 3474–348 (2020).
10.
Hua Y, Salcedo J. cost–effectiveness analysis of robotic-arm assisted total knee arthroplasty. PLOS ONE 17(11), e0277980 (2022).
11.
Varughese I, Whitehouse SL, Donnelly WJ, Crawford R. The cost effectiveness of unicompartmental versus total knee arthroplasty. J. Knee Surg. (2022) (Online ahead of print).
12.
Mahoney O, Kinsey T, Sodhi N et al. Improved component placement accuracy with robotic-arm assisted total knee arthroplasty. J. Knee Surg. 35(3), 337–344 (2022).
13.
Marchand RC, Sodhi N, Anis HK et al. One-year patient outcomes for robotic-arm assisted versus manual total knee arthroplasty. J. Knee Surg. 32(11), 1063–1068 (2019).
14.
Onggo JR, Onggo JD, De Steiger R, Hau R. Robotic-assisted total knee arthroplasty is comparable to conventional total knee arthroplasty: a meta-analysis and systematic review. Arch. Orthop. Trauma Surg. 140(10), 1533–1549 (2020).
15.
Ng N, Gaston P, Simpson PM, Macpherson GJ, Patton JT, Clement ND. Robotic arm-assisted versus manual total hip arthroplasty: a systematic review and meta-analysis. Bone Joint J. 103-B(6), 1009–1020 (2021).
16.
Kayani B, Konan S, Pietrzak JRT, Haddad FS. Iatrogenic bone and soft tissue trauma in robotic-arm assisted total knee arthroplasty compared with conventional jig-based total knee arthroplasty: a prospective cohort study and validation of a new classification system. J. Arthroplasty 33(8), 2496–2501 (2018).
17.
Hampp EL, Scholl L, Faizan A, Sodhi N, Mont MA, Westrich G. Comparison of iatrogenic soft tissue trauma in robotic-assisted versus manual partial knee arthroplasty. Surg. Technol. Int. 39, 419–426 (2021).
18.
Tompkins GS, Sypher KS, Li HF, Griffin TM, Duwelius PJ. Robotic versus manual total knee arthroplasty in high volume surgeons: a comparison of cost and quality metrics. J. Arthroplasty 37(8S), S782–S789 (2022).
19.
Kolessar DJ, Hayes DS, Harding JL, Rudraraju RT, Graham JH. Robotic-arm assisted technology's impact on knee arthroplasty and associated healthcare costs. J. Health Econ. Outcomes Res. 9(2), 57–66 (2022).
20.
Emara AK, Zhou G, Klika AK et al. Is there increased value in robotic arm-assisted total hip arthroplasty?: a nationwide outcomes, trends, and projections analysis of 4,699,894 cases. Bone Joint J. 103-B(9), 1488–1496 (2021).
21.
Kirchner GJ, Lieber AM, Haislup B, Kerbel YE, Moretti VM. The cost of robot-assisted total hip arthroplasty: comparing safety and hospital charges to conventional total hip arthroplasty. J. Am. Acad. Orthop. Surg. 29(14), 609–615 (2021).
22.
Clement ND, Gaston P, Hamilton DF et al. A cost-utility analysis of robotic arm-assisted total hip arthroplasty: using robotic data from the private sector and manual data from the national health service. Adv. Orthop. 2022, 5962260 (2022).
23.
Mont MA, Cool C, Gregory D, Coppolecchia A, Sodhi N, Jacofsky DJ. Health care utilization and payer cost analysis of robotic arm assisted total knee arthroplasty at 30, 60, and 90 days. J. Knee Surg. 34(3), 328–337 (2021).
24.
Cotter EJ, Wang J, Illgen RL. Comparative cost analysis of robotic-assisted and jig-based manual primary total knee arthroplasty. J. Knee Surg. 35(2), 176–184 (2022).
25.
Pierce J, Needham K, Adams C, Coppolecchia A, Lavernia C. Robotic-assisted total hip arthroplasty: an economic analysis. J. Comp. Eff. Res. 10(16), 1225–1234 (2021).
26.
Cool CL, Jacofsky DJ, Seeger KA, Sodhi N, Mont MA. A 90-day episode-of-care cost analysis of robotic-arm assisted total knee arthroplasty. J. Comp. Eff. Res. 8(5), 327–336 (2019).
27.
Ong KL, Coppolecchia A, Chen Z, Watson HN, Jacofsky D, Mont MA. Robotic-arm assisted total knee arthroplasty: cost savings demonstrated at one year. Clinicoecon. Outcomes Res. 14, 309–318 (2022).
28.
Cool CL, Needham KA, Khlopas A, Mont MA. Revision analysis of robotic arm-assisted and manual unicompartmental knee arthroplasty. J. Arthroplasty 34(5), 926–931 (2019).
29.
Clement ND, Deehan DJ, Patton JT. Robot-assisted unicompartmental knee arthroplasty for patients with isolated medial compartment osteoarthritis is cost-effective: a Markov decision analysis. Bone Joint J. 101-B(9), 1063–1070 (2019).
•• Markov decision analysis demonstrated that rUKA is a cost-effective alternative to manual TKA and UKA for the patients who have isolated medial compartment OA of the knee.
30.
Pierce J, Needham K, Adams C, Coppolecchia A, Lavernia C. Robotic arm-assisted knee surgery: an economic analysis. Am. J. Manag. Care 26(7), e205–e210 (2020).
31.
Fang CJ, Mazzocco JC, Sun DC et al. Total knee arthroplasty hospital costs by time-driven activity-based costing: robotic versus conventional. Arthroplast. Today 13, 43–47 (2022).
32.
Rajan PV, Khlopas A, Klika A, Molloy R, Krebs V, Piuzzi NS. The cost–effectiveness of robotic-assisted versus manual total knee arthroplasty: a Markov model-based evaluation. J. Am. Acad. Orthop. Surg. 30(4), 168–176 (2022).
•• Markov model demonstrated lower annualized revision rates and higher postoperative quality of life, with robotic-assisted TKAs potentially offering improved health outcomes.
33.
Grosso MJ, Li WT, Hozack WJ, Sherman M, Parvizi J, Courtney PM. Short-term outcomes are comparable between robotic-arm assisted and traditional total knee arthroplasty. J. Knee Surg. 35(7), 798–803 (2022).
34.
Maldonado DR, Go CC, Kyin C et al. Robotic arm-assisted total hip arthroplasty is more cost-effective than manual total hip arthroplasty: a Markov model analysis. J. Am. Acad. Orthop. Surg. 29(4), e168–e177 (2021).
35.
Gregory DA, Coppolecchia A, Scotti DJ, Chen Z, Mont MA, Jacofsky D. A 90-day episode-of-care analysis including computed tomography scans of robotic-arm assisted versus manual total knee arthroplasty. J. Knee Surg. 36(10), 1077–1086 (2023).
•• Analysis of commercial claims data showing reduced 90-day EOC cost for RATKA compared to MTKA including pre-operative CT cost. This longer-term perspective allows for a more thorough assessment of the impact of the surgical approach on patient outcomes and healthcare resource utilization.
36.
Barsoum W, Gregory D, Needham K et al. Advantages of robotic-arm assisted total hip arthroplasty: a 90-day episode-of-care cost and clinical utility analysis. 12(5), e220208 (2023).
• Analysis of commercial claims data showing reduced 90-day EOC cost for RATHA compared to MTHA including pre-operative CT cost.
37.
Marchand KB, Ehiorobo J, Mathew KK, Marchand RC, Mont MA. Learning curve of robotic-assisted total knee arthroplasty for a high-volume surgeon. J. Knee Surg. 35(04), 409–415 (2022).
38.
Sodhi N, Khlopas A, Piuzzi N et al. The learning curve associated with robotic total knee arthroplasty. J. Knee Surg. 31(01), 017–021 (2018).
39.
Kayani B, Konan S, Huq SS, Ibrahim MS, Ayuob A, Haddad FS. The learning curve of robotic-arm assisted acetabular cup positioning during total hip arthroplasty. Hip Int. 31(3), 311–319 (2021).
40.
Redmond JM, Gupta A, Hammarstedt JE, Petrakos AE, Finch NA, Domb BG. The learning curve associated with robotic-assisted total hip arthroplasty. J. Arthroplasty 30(1), 50–54 (2015).
41.
Chen Z, Bhowmik-Stoker M, Palmer M et al. Time-based learning curve for robotic-assisted total knee arthroplasty: a multicenter study. J. Knee Surg. 36(8), 873–877 (2023).
42.
Kayani B, Konan S, Huq SS, Tahmassebi J, Haddad FS. Robotic-arm assisted total knee arthroplasty has a learning curve of seven cases for integration into the surgical workflow but no learning curve effect for accuracy of implant positioning. Knee Surg. Sports Traumatol. Arthrosc. 27(4), 1132–1141 (2019).
43.
Shah R, Diaz A, Phieffer L et al. Robotic total knee arthroplasty: a missed opportunity for cost savings in Bundled Payment for Care Improvement initiatives? Surgery 170(1), 134–139 (2021).
•• Analysis of raTKA in bundled payment scenarios shows hospitals participating in the Bundled Payment for Care Improvement may experience cost-saving with increased utilization of robotic total knee arthroplasty.
44.
Khlopas A, Sodhi N, Sultan AA, Chughtai M, Molloy RM, Mont MA. Robotic arm-assisted total knee arthroplasty. J. Arthroplasty 33(7), 2002–2006 (2018).
45.
Marchand KB, Ehiorobo J, Mathew KK, Marchand RC, Mont MA. Learning curve of robotic-assisted total knee arthroplasty for a high-volume surgeon. J. Knee Surg. 35(4), 409–415 (2022).
46.
Siddiqi A, Mont MA, Krebs VE, Piuzzi NS. Not all robotic-assisted total knee arthroplasty are the same. J. Am. Acad. Orthop. Surg. 29(2), 45–59 (2021).
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© 2024 The authors. This work is licensed under the Attribution-NonCommercial-NoDerivatives 4.0 Unported License
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Received: 24 March 2023
Accepted: 21 December 2023
Published online: 15 March 2024
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Understanding economic analysis and cost–effectiveness of CT scan-guided, 3-dimensional, robotic-arm assisted lower extremity arthroplasty: a systematic review. (2024) Journal of Comparative Effectiveness Research. DOI: 10.57264/cer-2023-0040
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