Systematic review of health economic evaluation of robot-assisted hip and knee arthroplasty.

backgroundThe effectiveness of robot-assisted arthroplasty has been paid more attention, however, the question whether robotic technology could serve as a cost-effectiveness tool dealing with the ever-increasing knee and hip arthroplasty demand is still unclear. Health economic evaluations (HEEs) are comparative analyses of alternative interventions in terms of their costs and consequences. With increasing publications on the HEE of robot-assisted arthroplasty, there is a need to systematically clarify their framework and methodology. This review aimed to identify recent economic evaluations studies and to discuss their methods, cost and outcome, and reported conclusions.

methodsA systematic review of English language literature was conducted in PubMed, EMBASE, and the Web of Science and Cochrane Library from studies published up to February 2025. Two reviewers independently performed screening, full-text inclusion, and data extraction. The study quality of all included studies was assessed by the latest version Consolidated Health Evaluation Reporting Standards (CHEERS2022).

resultsThe search identified 478 publications, of which twenty-five studies met the inclusion criteria. Sixteen studies were conducted in the United States. Among these, thirteen evaluated total knee arthroplasty, six examined unicompartmental knee arthroplasty, and five focused on total hip arthroplasty. Economic modelling was the predominant study design, applied in thirteen studies, while ten were observational in nature and two were randomized controlled trials. A total of twenty-three studies were conducted from the healthcare system or payer perspective. Data were derived from various sources, including existing databases, clinical registries, single-center studies, and previously published literature. Cost-utility analysis was the most frequently employed economic evaluation method, used in eleven studies, followed by cost-consequence analysis in eight studies and cost-effectiveness analysis in six studies. The time horizons applied across studies ranged from 90 days to lifetime. Although considerable heterogeneity was observed in the reporting of costs and outcomes, the collective evidence indicated that robotic-assisted arthroplasty was generally cost-effective, with cost-effectiveness influenced by surgical volume, patient characteristics, and length of follow-up. The methodological quality of the included studies varied, with CHEERS 2022 reporting guideline adherence ranging from 57.9% to 96.0%.

conclusionsCurrent economic evaluations of robot-assisted arthroplasty, including cost-utility, cost-effectiveness analysis, and cost-consequence analyses, are highly heterogeneous in methodology, cost and outcome measures, and reported results. In addition, there is an urgent need to standardize the definition and measurement of both short-term and long-term cost and outcome indicators for robotic assist arthroplasty. Moreover, early-stage economic modeling and robust trial-based evaluations should be prioritized to better determine the long-term cost-effectiveness of robot-assisted arthroplasty.