机器人辅助全膝关节置换术的成本效益分析。
Cost-effectiveness analysis of robotic-arm assisted total knee arthroplasty.
机构信息
Department of Public Health Sciences, Division of Health Policy and Outcomes Research, University of Rochester Medical Center, Rochester, NY, United States of America.
Analysis Group, Inc., Boston, MA, United States of America.
出版信息
PLoS One. 2022 Nov 28;17(11):e0277980. doi: 10.1371/journal.pone.0277980. eCollection 2022.
PURPOSE
Total knee arthroplasty (TKA) is widely recognized as an effective treatment for end-stage knee osteoarthritis (OA). Compared with conventional TKA, robotic-arm assisted TKA may improve patients' functionality and resulting quality of life by more accurate and precise component placement. Currently, the literature on cost-effectiveness of robotic-arm assisted TKA in the US is limited. The objective of this study was to assess the cost-effectiveness of robotic-arm assisted TKA relative to TKA in the Medicare-aged population including exploring the impact of hospital volume on cost-effectiveness outcomes.
METHODS
We developed a decision-analytic model to evaluate the costs, health outcomes, and incremental cost-effectiveness ratio (ICER) of robotic-arm assisted TKA vs TKA in Medicare population with OA. We evaluated cost-effectiveness at a willingness-to-pay (WTP) threshold of $50,000 per quality-adjusted life-year (QALY). We sourced costs from the literature including episode-of-care (EOC) costs from a Medicare study. We assessed cost-effectiveness of robotic-arm assisted TKA by hospital procedure volume and conducted deterministic (DSA) and probabilistic sensitivity analysis (PSA).
RESULTS
For the average patient treated in a hospital with an annual volume of 50 procedures, robotic-arm assisted TKA resulted in a total QALY of 6.18 relative to 6.17 under conventional TKA. Total discounted costs per patient were $32,535 and $31,917 for robotic-arm assisted TKA and conventional TKA, respectively. Robotic-arm assisted TKA was cost-effective in the base case with an ICER of $41,331/QALY. In univariate DSA, cost-effectiveness outcomes were most sensitive to the annual hospital procedure volume. Robotic-arm assisted TKA was cost-effective at a WTP of $50,000/QALY only when hospital volume exceeded 49 procedures per year. In PSA, robotic-arm assisted TKA was cost-effective at a $50,000/QALY WTP threshold in 50.4% of 10,000 simulations.
CONCLUSIONS
Despite high robotic purchase costs, robotic-arm assisted TKA is likely to be cost-effective relative to TKA in the Medicare population with knee OA in high-volume hospitals through lowering revision rates and decreasing post-acute care costs. Higher-volume hospitals may deliver higher value in performing in robotic-arm assisted TKA.
目的
全膝关节置换术（TKA）被广泛认为是治疗膝关节骨关节炎（OA）终末期的有效方法。与传统 TKA 相比，机器人辅助 TKA 可以通过更精确的组件放置来提高患者的功能和生活质量。目前，美国关于机器人辅助 TKA 的成本效益的文献有限。本研究的目的是评估机器人辅助 TKA 相对于 Medicare 年龄组中 TKA 的成本效益，包括探讨医院量对成本效益结果的影响。
方法
我们开发了一种决策分析模型，以评估机器人辅助 TKA 相对于 Medicare 中 OA 患者的 TKA 的成本、健康结果和增量成本效益比（ICER）。我们在 Medicare 研究的病例治疗成本的基础上，以每质量调整生命年（QALY）50,000 美元的意愿支付（WTP）阈值来评估成本效益。我们通过医院手术量评估机器人辅助 TKA 的成本效益，并进行确定性分析（DSA）和概率敏感性分析（PSA）。
结果
对于在每年 50 例手术量的医院接受治疗的平均患者，机器人辅助 TKA 的总 QALY 为 6.18，而传统 TKA 为 6.17。每位患者的总折扣成本分别为机器人辅助 TKA 和传统 TKA 的 32,535 美元和 31,917 美元。在基本情况下，机器人辅助 TKA 的 ICER 为 41,331/QALY，具有成本效益。在单变量 DSA 中，成本效益结果对年度医院手术量最敏感。只有当医院每年的手术量超过 49 例时，机器人辅助 TKA 在 WTP 为 50,000 美元/QALY 时才具有成本效益。在 PSA 中，在 10,000 次模拟中的 50.4%中，机器人辅助 TKA 在 WTP 为 50,000 美元/QALY 的阈值下具有成本效益。
结论
尽管机器人购买成本很高，但在高容量医院中，机器人辅助 TKA 可能会通过降低翻修率和降低急性后护理成本而相对于 Medicare 膝关节 OA 患者的 TKA 具有成本效益。高容量医院在执行机器人辅助 TKA 方面可能会提供更高的价值。
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