BACKGROUND: Enabling technologies used in primary total hip arthroplasty (THA), including computer-assisted fluoroscopic navigation (cTHA) and robotic-assisted THA (rTHA), aim to optimize the accuracy and precision of surgery to improve patient outcomes. This study evaluates the cost-effectiveness of cTHA compared with manual THA (mTHA) and rTHA for primary THA in the United States, from an "all-payer" perspective. METHODS: A Markov state-transition model was developed to estimate costs and quality-adjusted life year gains over a 1-year time horizon. Inputs were primarily derived from published literature that analyzed data from an electronic healthcare database between 2016 and 2021. The model population consisted of patients undergoing primary THA, with a mean age of 66 years. The model included six health states: post-THA, readmission without revision, readmission with revision, post-readmission, post-revision, and death. Sensitivity analyses, including deterministic, probabilistic, and scenario analyses, were conducted to test the robustness of the results. RESULTS: cTHA demonstrated cost savings of 1595 compared with rTHA and 949 compared with mTHA. Savings with cTHA were primarily due to shorter length of stay and fewer readmissions with or without revision. cTHA also showed minor quality-adjusted life year gains of 0. 0013 and 0. 0009 versus rTHA and mTHA, respectively. These findings establish cTHA as the cost-effective strategy, combining lower costs with slightly improved health outcomes. Results remained robust across all sensitivity analyses. CONCLUSIONS: cTHA is the most cost-effective technique for primary THA in the United States, compared with both rTHA and mTHA.
Bernstein et al. (Mon,) studied this question.