3C-02 - Economic Outcomes for VELYS Robotic-Assisted Solution (VRAS) and MAKO for Total Knee Arthroplasty

Background: Robotic-assisted total knee arthroplasty (TKA) was developed to improve the quality of patient care and the provider experience by increasing surgical precision and reducing surgical variability. Robotic-assisted TKA improvements are intended to contribute to the achievement of the Quadruple Aim of healthcare, the goal of which is to simultaneously improve patient outcomes and population health, lower healthcare costs, and improve provider experience.

Objectives: This study assesses the economic outcomes of VELYS™ Robotic Assisted Solution (VRAS), the latest entrant in the field of robotic TKA technologies compared to the MAKO® Robotic Arm Assisted Surgery (MAKO), one of the first TKA robotic systems on the market.

Methods: A retrospective cohort study using the PINC AITM Database, a hospital-based data source, was conducted to evaluate economic outcomes for patients who received VRAS and MAKO primary TKA from January 1, 2022-April 30, 2023. Procedures involving VRAS and MAKO systems were identified through a fuzzy logic search within the PINC AI chargemaster. The primary endpoint was hospital cost during the index admission. Exploratory endpoints included costs within 30-, 60-, and 90-days following the procedures and a cost breakdown of the index hospitalization. A propensity score fine stratification and weighting approach was used for confounding adjustment. Standardized mean differences (SMD) < 0.20 indicated balance. Adjustment of remaining confounders with SMD >0.2 was carried out using generalized linear models for evaluating outcomes in matched cohorts. All cost outcomes were computed using gamma distribution.

Results: The study included 826 VRAS and 9,719 MAKO TKA cases with 90-day follow-up data. Mean age was 67.7 years old and most patients were married, female, and White. The surgeries were mostly outpatient and patients had Medicare or private commercial health insurance. The average hospital cost at index was significantly lower for VRAS ($14,887) compared to MAKO ($15,258, p-value < 0.01). Supply and operating room cost comprised more than 85% of total hospital cost at index. The knee related cost of care (index + follow-up cost) at 90-day follow-up was also significantly lower for VRAS ($15,044) compared to MAKO ($16,030).

Conclusions: This database study demonstrated that the use of VRAS for TKA was associated with lower hospital costs on a per patient basis, from the index admission through 90 days of follow-up when compared to TKA performed with MAKO. The findings suggest that utilization of VRAS rather than MAKO may further decrease hospital costs associated with TKA, thereby improving the cost-effectiveness of robotic TKA and contributing to the Quadruple Aim of healthcare.