Robotic total knee arthroplasty: A missed opportunity for cost savings in Bundled Payment for Care Improvement initiatives?

Can Technology Assistance be Cost Effective in TKA? A Simulation-Based Analysis of a Risk-prioritized, Practice-specific Framework

“…These findings are not disconsonant with those of several related studies, although there are numerous differences in approach. Several retrospective clinical studies have reported negative marginal costs for using robotic TKA due in part to claimed reductions in episode-of-care costs, although in our study any negative marginal costs we incorporated were primarily attributable to reductions in revision rate predicted by decreases in outliers resulting from improved surgical precision [16, 36, 46]. Recently, Rajan et al [43] used a Markov decision model to simulate the outcomes of patients who underwent TKA using conventional or robotic approaches and concluded that robotic surgery might prove to be cost effective for a practice volume of 200 TKAs per year; however, they used a revision rate for conventional procedures that was derived from a different source than the revision rate they used for robotic procedures, even though the robotic revision rate was derived from a review of 11 studies that collectively showed no differences in revision rates between conventional and robotic procedures.…”

“…If medical imaging costs were not included in a study reporting the costs of a robotic or PSI procedure, we assumed that a CT scan would need to be performed and added a fixed cost of USD 420, as reported [14], to account for this. For intraoperative per-case costs, we included line items related to elements such as TA-TKA disposables, medical imaging, instrument reprocessing, and operating room time [4,5,7,14,17,19,23,35,53,60], if reported, but we opted not to include costs or savings associated with inpatient or outpatient care such as differences in the cost of laboratory tests, length of stay, physical therapy, readmission, or use of post-acute care facilities because causal mechanisms associated with such costs are not fully understood and costs or savings linked to these items have only been reported in a limited number of settings [16,17,41,46]. If a specific practice wished to include such costs or savings in this model, it would be straightforward to do so.…”

Robotically Assisted Total Knee Arthroplasty - Literature Review

“…Cost studies including from surgery until 90 days after procedure showed the robotically assisted (RA) surgery could lead to savings of between US$ 587 to as much as US$ 4049, this being related to shorter hospital stay, lower complications rate, lower use of health assistance after hospital discharge and lower rate of readmissions [17][18][19].…”

Robotic-Arm Assisted Total Knee Arthroplasty: Cost Savings Demonstrated at One Year

“…However, some recent studies suggest that portions of RATKA may be more expensive or that the cost savings may not be as substantial. 23,28 Cotter and co-authors of a retrospective single-surgeon and single-institution database study compared 90-day EOC hospital costs for 139 MTKAs and 147 RATKAs performed from April 1, 2015 to September 30, 2017. 23 While total intra-operative costs to the hospital were higher when comparing RATKA ($10295.17) to MTKA ($9998.78; p < 0.001), inpatient costs were lower for RATKA ($3893.90) than MTKA ($5587.40; p < 0.001).…”

“…Shah et al compared the total RATKA EOC costs with MTKA within Medicare's bundled payment arrangement. 28 A total of 194,020 MTKAs and 4351 RATKAs within Bundled Payment for Care Improvement analytic file of the 100% Medicare Inpatient Standard Analytic Files were analyzed to compare risk-adjusted, price-standardized payments for the surgical episode from admission through 90-days postdischarge as well as outcomes, utilization, and spending between the procedures. The risk-adjusted EOC mean cost was found to be only $587 less for patients who underwent RATKA after 90 days, but these patients still had shorter lengths of stay and were discharged less frequently to a post-acute care facility.…”