Markov Model-Based Cost-Effectiveness Evaluation of ROSA® vs. Manual Total Knee Arthroplasty: Sweden Payer Perspective
Author(s)
Niraj Parikh, MS1, Nadine Jamous, BSc (Hons), PG Dip2, Anathea Cora Cristea, MMS (Med. Mgmt)3, Joy Ong, MSc3, Ardalan Rahimi, MD4.
1Global Director, Health Economics and Market Access, Zimmer Biomet, Warsaw, IN, USA, 2Zimmer Biomet, Swindon, United Kingdom, 3NHTA Sweden AB, Stockholm, Sweden, 4Orthopedic Section, Karolinska Institutet Danderyd Hospital, Danderyd, Sweden.
1Global Director, Health Economics and Market Access, Zimmer Biomet, Warsaw, IN, USA, 2Zimmer Biomet, Swindon, United Kingdom, 3NHTA Sweden AB, Stockholm, Sweden, 4Orthopedic Section, Karolinska Institutet Danderyd Hospital, Danderyd, Sweden.
OBJECTIVES: The purpose of this study was to investigate from the Sweden payer perspective the cost-effectiveness of ROSA® total knee arthroplasty (TKA) versus conventional manual TKA (mTKA).
METHODS: A Markov model simulated the lifetime outcomes of TKA of patients at average age 65 years. ROSA® costs included robot rental, service, and implant costs. For both groups, data from systematic reviews was used to determine early (<1 year) and late (> 1 year) revision rates after surgery. Basecase model evaluatin was limited to time-horizon of 3 years owing to implant contract limitations in Sweden. Outcomes were measured in quality-adjusted life-years (QALYs). Costs and effects were discounted at 3% and average annual number of procedures determined at 224 procedures. Costs and QALYs were organized into incremental cost-effectiveness ratios (ICERs). Willingness-to-pay (WTP) thresholds was set at SEK 750,000/QALY. One-way sensitivity analyses (OWSA), scenario analysis and probabilistic sensitivity analysis (PSA) evaluated the effect of data uncertainty.
RESULTS: ROSA® TKA produced 1.567 QALYs versus 1.566 QALYs for mTKA. Total costs per case for ROSA® TKA were SEK 96,923 (224 cases/robot, basecase). The basecase ICERs for ROSA® TKAs was dominant and net monetary benefit (NMB) calculated was SEK 9,698. The model remained cost-effective for lower annual number of cases (100 surgeries) but was not cost-effective at 50 surgeries. ICER at time horizon of 15 and 20 years did remain cost-effective. The model remained robust and dominant for the OWSA scenarios. PSA showed the probability of ROSA® being cost-effective at 78.3%.
CONCLUSIONS: ROSA® Knee System, an innovative technology demonstrates promising early clinical outcomes and improved short-term PROMs, and potential cost-savings compared to the current standard of care in patients with TKA procedure. As the technology becomes more available in Sweden, registry data and other research activities can contribute to our understanding the long-term benefits.
METHODS: A Markov model simulated the lifetime outcomes of TKA of patients at average age 65 years. ROSA® costs included robot rental, service, and implant costs. For both groups, data from systematic reviews was used to determine early (<1 year) and late (> 1 year) revision rates after surgery. Basecase model evaluatin was limited to time-horizon of 3 years owing to implant contract limitations in Sweden. Outcomes were measured in quality-adjusted life-years (QALYs). Costs and effects were discounted at 3% and average annual number of procedures determined at 224 procedures. Costs and QALYs were organized into incremental cost-effectiveness ratios (ICERs). Willingness-to-pay (WTP) thresholds was set at SEK 750,000/QALY. One-way sensitivity analyses (OWSA), scenario analysis and probabilistic sensitivity analysis (PSA) evaluated the effect of data uncertainty.
RESULTS: ROSA® TKA produced 1.567 QALYs versus 1.566 QALYs for mTKA. Total costs per case for ROSA® TKA were SEK 96,923 (224 cases/robot, basecase). The basecase ICERs for ROSA® TKAs was dominant and net monetary benefit (NMB) calculated was SEK 9,698. The model remained cost-effective for lower annual number of cases (100 surgeries) but was not cost-effective at 50 surgeries. ICER at time horizon of 15 and 20 years did remain cost-effective. The model remained robust and dominant for the OWSA scenarios. PSA showed the probability of ROSA® being cost-effective at 78.3%.
CONCLUSIONS: ROSA® Knee System, an innovative technology demonstrates promising early clinical outcomes and improved short-term PROMs, and potential cost-savings compared to the current standard of care in patients with TKA procedure. As the technology becomes more available in Sweden, registry data and other research activities can contribute to our understanding the long-term benefits.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE573
Topic
Economic Evaluation, Medical Technologies
Disease
Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal), Surgery