Computer-Assisted Fluoroscopic Navigation Is Cost Effective Compared To Robotic-Assisted And Manual Surgery In Total Hip Arthroplasty
Author(s)
Jenna Bernstein, MD1, Jean-Baptiste Trouiller, MSc2, Mina Kabiri, PhD3, William Hamilton, MD4;
1Connecticut Orthopaedics, Hamden, CT, USA, 2Johnson & Johnson MedTech, Paris, France, 3Johnson & Johnson MedTech, Raynham, MA, USA, 4Anderson Orthopedic Clinic, Arlington, VA, USA
1Connecticut Orthopaedics, Hamden, CT, USA, 2Johnson & Johnson MedTech, Paris, France, 3Johnson & Johnson MedTech, Raynham, MA, USA, 4Anderson Orthopedic Clinic, Arlington, VA, USA
Presentation Documents
OBJECTIVES: Total hip arthroplasty (THA) is among the most common surgeries for hip osteoarthritis. Besides the conventional manual technique (mTHA), alternatives such as computer-assisted fluoroscopic navigation (cTHA) and robotic-assisted solutions (rTHA) are available for THA, each influencing costs and patients’ quality of life. We aimed to estimate the cost-utility of cTHA compared to rTHA and mTHA in patients undergoing THA from the US healthcare system perspective.
METHODS: A Markov model was developed to compare costs and utilities of cTHA vs. mTHA, and cTHA vs. rTHA over a 1-year time horizon with 3-month cycle length. Health states were defined based on the occurrence of readmissions with/without revisions. Reasons for readmission/revision included fracture, dislocation, infection and hip pain. Utilities were presented in quality-adjusted life years (QALYs). Cost components included length of stay, operative time and readmissions/revisions. Incremental cost-effectiveness ratio (ICER) was estimated as incremental cost per QALY change for each pairwise comparison. Inputs were drawn from published literature. Sensitivity analyses were performed to test the robustness of results.
RESULTS: cTHA was associated with estimated savings of $1,595 and $949 per patient compared to rTHA and mTHA, respectively. Results showed a slight QALY gain of 0.001 compared to both rTHA and mTHA. Results indicated that cTHA was the ‘dominant’ strategy, i.e. reducing costs and slightly increasing QALYs, compared to both alternatives. Probabilistic sensitivity analysis indicated that cTHA was cost saving in 100% of the 1,000 simulations compared to both rTHA and mTHA.
CONCLUSIONS: Using computer-assisted fluoroscopic navigation in primary THA showed costs savings and a slight improvement in quality of life compared to robotic-assisted and manual THA. Results suggest that computer-assisted fluoroscopic navigation is the preferred strategy for primary THA mainly due to its impact on downstream cost savings incurred by reductions in OR time and readmissions/revisions rates.
METHODS: A Markov model was developed to compare costs and utilities of cTHA vs. mTHA, and cTHA vs. rTHA over a 1-year time horizon with 3-month cycle length. Health states were defined based on the occurrence of readmissions with/without revisions. Reasons for readmission/revision included fracture, dislocation, infection and hip pain. Utilities were presented in quality-adjusted life years (QALYs). Cost components included length of stay, operative time and readmissions/revisions. Incremental cost-effectiveness ratio (ICER) was estimated as incremental cost per QALY change for each pairwise comparison. Inputs were drawn from published literature. Sensitivity analyses were performed to test the robustness of results.
RESULTS: cTHA was associated with estimated savings of $1,595 and $949 per patient compared to rTHA and mTHA, respectively. Results showed a slight QALY gain of 0.001 compared to both rTHA and mTHA. Results indicated that cTHA was the ‘dominant’ strategy, i.e. reducing costs and slightly increasing QALYs, compared to both alternatives. Probabilistic sensitivity analysis indicated that cTHA was cost saving in 100% of the 1,000 simulations compared to both rTHA and mTHA.
CONCLUSIONS: Using computer-assisted fluoroscopic navigation in primary THA showed costs savings and a slight improvement in quality of life compared to robotic-assisted and manual THA. Results suggest that computer-assisted fluoroscopic navigation is the preferred strategy for primary THA mainly due to its impact on downstream cost savings incurred by reductions in OR time and readmissions/revisions rates.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE388
Topic
Economic Evaluation
Disease
SDC: Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal), STA: Surgery