Cost‐effectiveness of a novel, fluoroscopy‐based robotic‐assisted total hip arthroplasty system: A Markov analysis

Abstract

BackgroundThe purpose of this study was to assess the cost‐effectiveness of a novel, fluoroscopy‐based robotic‐assisted total hip arthroplasty (RA‐THA) system compared to a manual unassisted technique (mTHA) up to 5 years post‐operatively.MethodsA Markov model was constructed to compare the cost‐effectiveness of RA‐THA and mTHA. Cost‐effectiveness was defined as an Incremental Cost‐Effectiveness Ratio (ICER) <$50 000 or $100 000 per Quality Adjusted Life Year (QALY).ResultsRA‐THA patients experienced lower costs compared to mTHA patients at 1 year ($20 865.12 ± 9897.52 vs. $21 660.86 ± 9909.15; p < 0.001) and 5 years ($23 124.57 ± 10 045.48 vs. $25 756.42 ± 10 091.84; p < 0.001) post‐operatively. RA‐THA patients also accrued more QALYs (1‐year: 0.901 ± 0.117 vs. 0.888 ± 0.114; p < 0.001; 5‐years: 4.455 ± 0.563 vs. 4.384 ± 0.537 p < 0.001). Overall, RA‐THA was cost‐effective (1‐year ICER: $−61 210.77; 5‐year ICER: $−37 068.31).ConclusionsThe novel, fluoroscopy‐based RA‐THA system demonstrated cost‐effectiveness when compared to manual unassisted THA.

Robotic-assisted Total Hip Arthroplasty Utilizing a Fluoroscopy-guided System Produced Similar Cup Accuracy and Precision Relative to a Computerized Tomography-based Robotic Platform

“…The 81.6% of cups placed within the Lewinnek zone in the FL-RTHA cohort is comparable to the 87% reported in a recent study by Stewart et al, who utilized the CT-RTHA system for DAA THA [35]. When considering the overall net bene ts to the patient, this ~1° difference in accuracy should be weighed against the potential for improved cost-effectiveness [12,15], reduced operative times and pin-less work ow, and radiation exposure in the FL-RTHA cohort relative to the CT-RTHA cohort [16,17].…”

“…Though the intra-operative use of robotics may improve component positioning, widespread adoption may be limited to certain factors. The most prevalent robotic THA technique utilizes a computerized tomography (CT) based work ow (CT-RTHA), and requires the use of costly per-case disposables ranging from $750-$1,300 [12]. A CT-based platform also increases operative and overall operating room times [13].…”

“…In an attempt to address these concerns, a novel, uoroscopy-based robotic assistance platform (FL-RTHA) was developed and brought to U.S. market in 2021. While early results have demonstrated potentially improved cost-effectiveness [12,15], and reduced operative times and radiation exposure relative to CT-RTHA [16,17], there has yet to be a direct comparison of the intra-operative performance with regards to acetabular cup placement between these two work ows. Therefore, the purpose of this investigation was to compare both accuracy and precision outcomes for cup placement for primary THA between a FL-RTHA system and the predicate CT-RTHA platform.…”