Robotic arm-assisted medial compartment knee arthroplasty is a cost-effective intervention at ten-year follow-up.

IF 4.9 1区医学 Q1 ORTHOPEDICS

Bone & Joint Journal Pub Date : 2025-01-01 DOI:10.1302/0301-620X.107B1.BJJ-2024-0245.R2

Mark J G Blyth, Nick D Clement, Xin Y Choo, James Doonan, Angus MacLean, Bryn G Jones

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引用次数: 0

Abstract

Aims: The aim of this study was 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 medial unicompartmental knee arthroplasty (rUKA) compared to manual (mUKA).

Methods: Ten-year follow-up of patients who were randomized to rUKA (n = 64) or mUKA (n = 65) was performed. Patients completed the EuroQol five-dimension health questionnaire preoperatively, at three months, and one, two, five, and ten years postoperatively, which was used to calculate quality-adjusted life years (QALY) gained and the incremental cost-effectiveness ratio (ICER). Costs for the index and additional surgery and healthcare costs were calculated.

Results: mUKA had a lower survival for reintervention (84.8% (95% CI 76.2 to 93.4); p = 0.001), all-cause revision (88.9% (95% CI 81.3 to 96.5); p = 0.007) and aseptic revision (91.9% (95% CI 85.1 to 98.7); p = 0.023) when compared to the rUKA group at ten years, which was 100%. The rUKA group had a greater QALY gain per patient (mean difference 0.186; p = 0.651). Overall rUKA was the dominant intervention, being cost-saving and more effective with a greater health-related quality of life gain. On removal of infected reinterventions (n = 2), the ICER was £757 (not discounted) and £481 (discounted). When including all reintervention costs, rUKA was cost-saving when more than 100 robotic cases were performed per year. When removing the infected cases, rUKA was cost-saving when undertaking more than 800 robotic cases per year.

Conclusion: rUKA had lower reintervention and revision risks at ten years, which was cost-saving and associated with a greater QALY gain, and was the dominant procedure. When removing the cost of infection, which could be a random event, rUKA was a cost-effective intervention with an ICER (£757) which was lower than the willingness-to-pay threshold (£20,000).

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机械臂辅助内侧隔室膝关节置换术是一种具有成本效益的干预措施。

目的：本研究的目的是进行增量成本-效用分析，并评估与人工（mUKA）相比，机械臂辅助内侧单室膝关节置换术（rUKA）的差异成本和病例量对成本效益的影响。方法：对随机选择rUKA组（64例）和mUKA组（65例）的患者进行10年随访。患者术前、术后3个月、1年、2年、5年、10年分别填写EuroQol五维健康问卷，用于计算获得的质量调整生命年（QALY）和增量成本-效果比（ICER）。计算了该指数的成本以及额外的手术和医疗费用。结果：mUKA的再干预生存率较低(84.8% (95% CI 76.2 ~ 93.4)；p = 0.001)，全因修正（88.9%,95% CI 81.3 ~ 96.5）；p = 0.007)和无菌修订(91.9% (95% CI 85.1 ~ 98.7)；p = 0.023)，与十年后的rUKA组相比，成功率为100%。rUKA组每位患者的QALY增加更大(平均差0.186；P = 0.651)。总的来说，rUKA是主要的干预措施，节省了成本，更有效，健康相关的生活质量也得到了提高。在移除受感染的再干预物（n = 2）时，ICER为757英镑（未打折）和481英镑（打折）。当包括所有再干预费用时，rUKA每年进行100多例机器人手术，节省了成本。在移除感染病例时，rUKA每年使用800多台机器人进行手术，节省了成本。结论：rUKA术后10年再干预和翻修风险较低，节省成本，QALY获益较大，是优势手术。在排除感染成本（这可能是一个随机事件）后，rUKA是一种具有成本效益的干预措施，其ICER（757英镑）低于支付意愿阈值（2万英镑）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Bone & Joint Journal ORTHOPEDICS-SURGERY

CiteScore

9.40

自引率

10.90%

发文量

318

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