Dear CSS Members and Colleagues:
Enclosed is an article about robotic surgery in orthopedics. Even if you haven’t thought about this it will be coming your way, or at least an alternative will arrive to your operating room soon. There is conflicting data on the cost effectiveness and, indeed, clinical effectiveness of this technology; however, this may be the result of how we measure value. Porter (Porter M and Lee T: The Strategy that will Fix Healthcare. HBS.org, Oct. 2013) has defined Value in three tiers:
Tier 1: This is the Degree of recovery. It is the initial outcome, and as such, it is often used to determine if a technology or new implant is clinically effective as well as cost effective.
Tier 2: This is the Process of recovery. To the degree new technology changes this we can measure the impact.
Tier 3: This is sustainability (durability) of the outcome. This is often not measured effectively. For example, if we do an operation differently than a standard method, we may not detect a difference unless the follow-up is sufficiently long. This may exceed the time used to determine the clinical and cost effectiveness. Fortunately, for innovations such as cross-linked polyethylene, we have now had not only basic wear studies but clinical outcome studies, but for some time there was no clarity on the superiority of conventional polyethylene. It may be the same with Robotic technology and mixed media, as the initial benefits may not differentiate these, and longer follow-up will show lower failure rates and greater durability.
Another important factor may be capital expense. It may well prove to be the case the mixed media provides a comparatively better value than robotics due to initial technology expense. These are concepts we’ll briefly consider at our next CSS Meeting. In 2020, the CSS meeting will be entirely devoted to the impact of Robotics, Navigation and Mixed Media (VR, AR, AI) on clinical outcomes and cost of care for shoulder arthroplasty.
“JP” Warner, MD