title: Can Robot-Assisted Unicompartmental Knee Arthroplasty Be Cost-Effective? A Markov Decision Analysis.
abstract: BACKGROUND
  Unicompartmental knee arthroplasty (UKA) is a treatment option for single-compartment knee osteoarthritis. Robotic assistance may improve survival rates of UKA, but the cost-effectiveness of robot-assisted UKA is unknown. The purpose of this study was to delineate the revision rate, hospital volume, and robotic system costs for which this technology would be cost-effective.
  
  
  METHODS
  We created a Markov decision analysis to evaluate the costs, outcomes, and incremental cost-effectiveness of robot-assisted UKA in 64-year-old patients with end-stage unicompartmental knee osteoarthritis.
  
  
  RESULTS
  Robot-assisted UKA was more costly than traditional UKA, but offered a slightly better outcome with 0.06 additional quality-adjusted life-years at an incremental cost of $47,180 per quality-adjusted life-years, given a case volume of 100 cases annually. The system was cost-effective when case volume exceeded 94 cases per year, 2-year failure rates were below 1.2%, and total system costs were <$1.426 million.
  
  
  CONCLUSIONS
  Robot-assisted UKA is cost-effective compared with traditional UKA when annual case volume exceeds 94 cases per year. It is not cost-effective at low-volume or medium-volume arthroplasty centers.
authors.affiliation: Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: Wayne E
authors.initials: WE
authors.lastname: Moschetti
authors.affiliation: Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Konopka
authors.affiliation: Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Harry E
authors.initials: HE
authors.lastname: Rubash
authors.affiliation: Steadman-Hawkins Clinic, Denver, Colorado.
authors.forename: James W
authors.initials: JW
authors.lastname: Genuario
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D006761:Hospitals; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D008390:Markov Chains; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery; D019057:Quality-Adjusted Life Years; D012086:Reoperation / Q000191:economics; D012371:Robotics / Q000191:economics*; D015996:Survival Rate
keywords: cost; cost-effectiveness; economic analysis; robotic assistance; unicompartmental arthroplasty