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A Cost-Utility Analysis of Robotic Arm-Assisted Total Hip Arthroplasty: Using Robotic Data from the Private Sector and Manual Data from the National Health Service

Clement, N. D.; Gaston, P.; Hamilton, D. F.; Bell, A.; Simpson, P.; Macpherson, G. J.; Patton, J. T.


N. D. Clement

P. Gaston

D. F. Hamilton

A. Bell

P. Simpson

G. J. Macpherson

J. T. Patton


Purpose. The aim was to assess the cost-effectiveness of robotic arm-assisted total hip arthroplasty (rTHA) compared with manual total hip arthroplasty (mTHA) and to assess the influence of annual volume on the relative cost-effectiveness of rTHA. Methods. A database of both rTHA (n = 48 performed in a private centre) and mTHA (n = 512 performed in the National Health Service) was used. Patient demographics, preoperative Oxford hip score, forgotten joint score, EuroQol 5-dimensional 3-level (EQ-5D), and postoperative EQ-5D were recorded. Two models for incremental cost-effectiveness ratios using cost per quality-adjusted life year (QALY) for rTHA were calculated based on a unit performing 100 rTHAs per year: 10-year follow-up and a lifetime time horizon (remaining life expectancy of a 69-year-old patient). Results. When adjusting for confounding factors, rTHA was independently associated with a 0.091 () greater improvement in the EQ-5D compared to mTHA. This resulted in a 10-year time horizon cost per QALY for rTHA of £1,910 relative to mTHA, which increased to £2,349 per QALY when discounted (5%/year). When using the 10-year time horizon cost per QALY was approximately £3,000 for a centre undertaking 50 rTHAs per year and decreased to £1,000 for centre undertaking 200 rTHAs per year. Using a lifetime horizon, the incremental unadjusted cost per QALY gained was £980 and £1432 when discounted (5%/year) for rTHA compared with mTHA. Conclusions. Despite the increased cost associated with rTHA, it was a cost-effective intervention relative to mTHA due to the associated greater health-related quality of health gain, according to the EQ-5D outcome measure.

Journal Article Type Article
Acceptance Date Jan 31, 2022
Online Publication Date Feb 27, 2022
Publication Date Feb 27, 2022
Deposit Date Mar 7, 2022
Publicly Available Date Mar 7, 2022
Journal Advances in Orthopedics
Electronic ISSN 2090-3472
Publisher Hindawi
Peer Reviewed Peer Reviewed
Volume 2022
Article Number 5962260
Public URL


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