Cost-utility analysis of robotic arm-assisted medial compartment knee arthroplasty.

Autor:	Clement ND; Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK., Fraser E; Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK., Gilmour A; Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK., Doonan J; Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK., MacLean A; Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK., Jones BG; Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK., Blyth MJG; Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK.
Jazyk:	angličtina
Zdroj:	Bone & joint open [Bone Jt Open] 2023 Nov 23; Vol. 4 (11), pp. 889-899. Date of Electronic Publication: 2023 Nov 23.
DOI:	10.1302/2633-1462.411.BJO-2023-0090.R1
Abstrakt:	Aims: To perform an incremental cost-utility analysis and assess the impact of differential costs and case volume on the cost-effectiveness of robotic arm-assisted unicompartmental knee arthroplasty (rUKA) compared to manual (mUKA). Methods: This was a five-year follow-up study of patients who were randomized to rUKA (n = 64) or mUKA (n = 65). Patients completed the EuroQol five-dimension questionnaire (EQ-5D) preoperatively, and at three months and one, two, and five years postoperatively, which was used to calculate quality-adjusted life years (QALYs) gained. Costs for the primary and additional surgery and healthcare costs were calculated. Results: rUKA was associated with a relative 0.012 QALY gain at five years, which was associated with an incremental cost per QALY of £13,078 for a unit undertaking 400 cases per year. A cost per QALY of less than £20,000 was achieved when ≥ 300 cases were performed per year. However, on removal of the cost for a revision for presumed infection (mUKA group, n = 1) the cost per QALY was greater than £38,000, which was in part due to the increased intraoperative consumable costs associated with rUKA (£626 per patient). When the absolute cost difference (operative and revision costs) was less than £240, a cost per QALY of less than £20,000 was achieved. On removing the cost of the revision for infection, rUKA was cost-neutral when more than 900 cases per year were undertaken and when the consumable costs were zero. Conclusion: rUKA was a cost-effective intervention with an incremental cost per QALY of £13,078 at five years, however when removing the revision for presumed infection, which was arguably a random event, this was no longer the case. The absolute cost difference had to be less than £240 to be cost-effective, which could be achieved by reducing the perioperative costs of rUKA or if there were increased revision costs associated with mUKA with longer follow-up. Competing Interests: M. J. G. Blyth received an institutional grant (paid to Glasgow Royal Infirmary Research Department) from MAKO Surgical Corporation (Stryker Ltd) to undertake this study. (© 2023 Blyth et al.)
Databáze:	MEDLINE
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