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.

Abstract

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.

Citation

Clement, N. D., Gaston, P., Hamilton, D. F., Bell, A., Simpson, P., Macpherson, G. J., & Patton, J. T. (2022). 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. Advances in orthopedics, 2022, Article 5962260. https://doi.org/10.1155/2022/5962260

• 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
• DOI: https://doi.org/10.1155/2022/5962260
• Public URL: http://researchrepository.napier.ac.uk/Output/2850964