Ratti Matteo, Ceriotti Daniele, Rescinito Riccardo, Bibi Rabia, Panella Massimiliano
Department of Translational Medicine (DiMeT), Università del Piemonte Orientale, 28100 Novara, Italy.
Habilita S.p.A., Casa di Cura Villa Igea, Str. Moirano, 2, 15011 Acqui Terme, Italy.
Healthcare (Basel). 2024 Aug 19;12(16):1650. doi: 10.3390/healthcare12161650.
BACKGROUND: Even if robotic assisted total knee arthroplasty (RATKA) is a widely used technique, there is still a gap of knowledge about whether this technology is effective in improving the patient utility. This measure is of paramount importance for conducting cost effectiveness analysis. The aim of this study was to compare the utility measure derived from self-reported outcomes questionnaires in patients who underwent RATKA compared to patients who underwent the manual surgery. METHODS: We compared 72 patients operated with a robotic technique with 70 operated with traditional technique. The utility data were collected with the WOMAC (Western Ontario and McMaster University Osteoarthritis index) self-administrated questionnaire that investigates pain, stiffness and functionality of the patients, an then mapped to a utility value through a validated transforming function. We performed three surveys: the first one before the intervention (t0), the second one 1 year after the surgery (t1) and the third one at the 2 year follow up (t2). RESULTS: we observed higher utility values in both groups. In detail, the mean utility score in the RATKA group increased from 0.37 to 0.71 (t1) and 0.78 (t2), while in the conventional group it increased from 0.41 to 0.78 (t1) and 0.78 (t2). The fixed effect coefficients of t1 and t2 were found to be 0.37 and 0.363 ( < 0.001 for both). The coefficient of the robotic technique, along with its interaction with the t1 and t2 time effect was non-significant. CONCLUSIONS: Even if at t1 the utility of patient who underwent RATKA were lower, at longer follow up (t2) we found no significant difference compared to traditional technique, leaving the superiority of robotic assisted technique yet to be proved. Our results may be useful for calculating the gained or lost Quality Adjusted Life Years (QALYs), so that the health care system (or an insurance company) could make an appropriate decision whether to fund the robotic approach or not, after a careful assessment of the incremental costs incurred.
背景：尽管机器人辅助全膝关节置换术（RATKA）是一种广泛应用的技术，但对于该技术在提高患者效用方面是否有效，仍存在知识空白。这一指标对于进行成本效益分析至关重要。本研究的目的是比较接受RATKA手术的患者与接受手动手术的患者，从自我报告结局问卷中得出的效用指标。 方法：我们将72例接受机器人技术手术的患者与70例接受传统技术手术的患者进行了比较。效用数据通过WOMAC（西安大略和麦克马斯特大学骨关节炎指数）自我管理问卷收集，该问卷调查患者的疼痛、僵硬和功能，然后通过经过验证的转换函数映射为效用值。我们进行了三次调查：第一次在干预前（t0），第二次在手术后1年（t1），第三次在2年随访时（t2）。 结果：我们观察到两组的效用值均较高。具体而言，RATKA组的平均效用评分从0.37提高到0.71（t1）和0.78（t2），而传统组则从0.41提高到0.78（t1）和0.78（t2）。发现t1和t2的固定效应系数分别为0.37和0.363（两者均<0.001）。机器人技术的系数及其与t1和t2时间效应的相互作用不显著。 结论：尽管在t1时，接受RATKA手术的患者的效用较低，但在更长时间的随访（t2）中，我们发现与传统技术相比没有显著差异，机器人辅助技术的优越性尚待证明。我们的结果可能有助于计算获得或损失的质量调整生命年（QALY），以便医疗保健系统（或保险公司）在仔细评估所产生的增量成本后，能够就是否资助机器人方法做出适当的决定。
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