Can Robotic Arm-assisted Total Knee Arthroplasty Remain Cost-effective in Volume-based Procurement System in China? A Markov Model-based Study

Abstract

Objective: The volume based procurement (VBP) program in China was initiated in 2022. The cost-effectiveness of robotic arm assisted total knee arthroplasty is yet uncertain after the initiation of the program. The objective of the study was to investigate the cost-effectiveness of robotic arm-assisted total knee arthroplasty and the influence of the VBP program to its cost-effectiveness in China.

Methods: The study was a Markov model-based cost-effectiveness study. Cases of primary total knee arthroplasty from January 2019 to December 2021 were included retrospectively. A Markov model was developed to simulate patients with advanced knee osteoarthritis. Manual and robotic arm-assisted total knee arthroplasties were compared for cost-effectiveness before and after the engagement of the VBP program in China. Probability and sensitivity analysis were conducted.

Results: Robotic arm-assisted total knee arthroplasty showed better recovery and lower revision rates before and after initiation of the VBP program. Robotic arm-based TKA was superior to manual total knee arthroplasty, with an increased effectiveness of 0.26 (16.87 vs 16.61) before and 0.52 (16.96 vs 16.43) after the application of Volume-based procurement, respectively. The procedure is more cost-effective in the new procurement system (17.13 vs 16.89). Costs of manual or robotic arm-assisted TKA were the most sensitive parameters in our model.

Conclusion: Based on previous and current medical charging systems in China, robotic arm-assisted total knee arthroplasty is a more cost-effective procedure compared to traditional manual total knee arthroplasty. As the volume-based procurement VBP program shows, the procedure can be more cost-effective.

Keywords

Cost-effectiveness analysis / Markov decision model / Robotic arm-assisted / Total knee arthroplasty

References

[1] KayaniB, KonanS, TahmassebiJ, Pietrzak JRT, HaddadFS. Robotic-arm assisted total knee arthroplasty is associated with improved early functional recovery and reduced time to hospital discharge compared with conventional jig-based total knee arthroplasty: a prospective cohort study. Bone Joint J. 2018;100-B:930–937.

[2] KhlopasA, SodhiN, SultanAA, Chughtai M, MolloyRM, MontMA. Robotic arm-assisted total knee arthroplasty. J Arthroplasty. 2018;33(7):2002–2006.

[3] MannanA, VunJ, LodgeC, Eyre-Brook A, JonesS. Increased precision of coronal plane outcomes in robotic-assisted total knee arthroplasty: a systematic review and meta-analysis. Surgeon. 2018;16(4):237–244.

[4] MarchandRC, SodhiN, KhlopasA, Sultan AA, HigueraCA, StearnsKL, et al. Coronal correction for severe deformity using robotic-assisted total knee arthroplasty. J Knee Surg. 2018;31(1):2–5.

[5] LiZ, ChenX, WangX, Zhang B, WangW, FanY, et al. HURWA robotic-assisted total knee arthroplasty improves component positioning and alignment–a prospective randomized and multicenter study. J Orthop Translat. 2022;33:31–40.

[6] GrauL, Lingamfelter M, PonzioD, PostZ, OngA, LeD, et al. Robotic arm assisted total knee arthroplasty workflow optimization, operative times and learning curve. Arthroplast Today. 2019;5(4):465–470.

[7] KayaniB, KonanS, AyuobA, Onochie E, Al-JabriT, HaddadFS. Robotic technology in total knee arthroplasty: a systematic review. EFORT Open Rev. 2019;4(10):611–617.

[8] SmithTJ, Siddiqi A, ForteSA, JudiceA, SculcoPK, VigdorchikJM, et al. Periprosthetic fractures through tracking pin sites following computer navigated and robotic total and unicompartmental knee arthroplasty. JBJS Rev. 2021;9(1):e20 00091.

[9] DakinH, EibichP, BeardD, Gray A, PriceA. The use of patient-reported outcome measures to guide referral for hip and knee arthroplasty. Bone Joint J. 2020;102-B(7):950–958.

[10] VermueH, TackP, GrysonT, Victor J. Can robot-assisted total knee arthroplasty be a cost-effective procedure? A markov decision analysis. Knee. 2021;29:345–352.

[11] RajanPV, Khlopas A, KlikaA, MolloyR, KrebsV, PiuzziNS. The cost-effectiveness of robotic-assisted versus manual Total knee arthroplasty: a Markov model-based evaluation. J Am Acad Orthop Surg. 2022;30(4):168–176.

[12] ZhangJJY, ChenJY, TayDKJ, Pang HN, YeoSJ, LiowMHL. Cost-effectiveness of robot-assisted total knee arthroplasty: a Markov decision analysis. J Arthroplasty. 2023;38:1434–1437.

[13] ZhangJ, NdouWS, NgN, GastonP, SimpsonPM, Macpherson GJ, et al. Robotic-arm assisted total knee arthroplasty is associated with improved accuracy and patient reported outcomes: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2021;30:2677–2695.

[14] XiaR, TongZ, HuY, KongK, WuX, LiH. 'Skywalker' surgical robot for total knee arthroplasty: an experimental sawbone study. Int J Med Robot. 2021;17:e2292.

[15] ZhangY, ZhangH, ClarkeHD, Hattrup SJ. Analysis of total joint arthroplasty costs in Chinese patients. J Arthroplasty. 2012;27(8):1423–1428.e1.

[16] LanRH, YuJ, SamuelLT, Pappas MA, BrooksPJ, KamathAF. How are we measuring cost-effectiveness in total joint arthroplasty studies? Systematic review of the literature. J Arthroplasty. 2020;35(11):3364–3374.

[17] GuiQ, ZhangX, LiuL, ZhaoF, ChengW, Zhang Y. Cost-utility analysis of total knee arthroplasty for osteoarthritis in a regional medical center in China. Health Econ Rev. 2019;9(1):15.

[18] LongH, XieD, ZengC, Wang H, LeiG, YangT. Burden and characteristics of revision total knee arthroplasty in China: a national study based on hospitalized cases. J Arthroplasty. 2023;38(7):1320–1325.e2.

[19] Statistical Communiqué of the People's Republic of China on the 2021 National Economic and Social Development. Beijing, China: National Bureau of Statistics of China; 2022

[20] HusereauD, Drummond M, AugustovskiF, de Bekker-GrobE, BriggsAH, CarswellC, et al. Consolidated health economic evaluation reporting standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. BMJ. 2022;376:e067975.

[21] SonnenbergFA, BeckJR. Markov models in medical decision making: a practical guide. Med Decis Making. 1993;13(4):322–338.

[22] KomorowskiM, RaffaJ. Markov models and cost effectiveness analysis: applications in medical research. Secondary analysis of electronic health records. Cham (CH): Springer; 2016. p. 351–367.

[23] SmareC, Lakhdari K, DoanJ, PosnettJ, JohalS. Evaluating partitioned survival and Markov decision-analytic modeling approaches for use in cost-effectiveness analysis: estimating and comparing survival outcomes. Pharmacoeconomics. 2020;38(1):97–108.

RIGHTS & PERMISSIONS

2024 The Authors. Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.