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Kostenanalyse zur Navigation in der Knieendoprothetik

Cost analysis for navigation in knee endoprosthetics

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Zusammenfassung

Hintergrund

Die Implantation von Knietotalendoprothesen (Knie-TEP) gehört zu den häufigsten Operationen in der Orthopädie und Unfallchirurgie. Der Erfolg hängt neben patientenassoziierten Faktoren und einem suffizienten Weichteilbalancing wesentlich von der korrekten Ausrichtung der Komponenten ab. Ein Instrument zur Verbesserung der Implantationsgenauigkeit stellt die computerassistierte Navigation dar, deren höhere Präzision in Bezug auf die Beinachse belegt ist. Dieses Verfahren ist in Europa und Nordamerika etabliert. Im deutschen DRG-System werden die damit verbundenen Aufwendungen bisher nicht vergütet. Ziel der Untersuchung ist deshalb eine Analyse der Kosten bei Implantation einer Knie-TEP mittels computerassistierter Navigation gegenüber der konventionellen Technik.

Methodik

Es wurden die Anschaffungskosten verschiedener Navigationssysteme (Abschreibungsmodelle über 5 und 10 Jahre), die jährlichen Kosten für Wartung und Software-Updates sowie die pro Operation anfallenden Kosten (Verbrauchsmaterial, Verlängerung der Operationszeit) berücksichtigt. Die zusätzliche Operationszeit wurde anhand einer Metaanalyse der aktuellen Literatur ermittelt. Es wurden Modellsituationen mit 25, 50, 100, 200 und 500 navigierten Knie-TEP/Jahr berechnet.

Ergebnisse

Die Höhe der finanziellen Mehrbelastung durch die computerassistierte Navigation hängt hauptsächlich vom jährlichen Operationsvolumen und der Verlängerung der Operationszeit ab. Eine relevante Verringerung der zusätzlich entstehenden Kosten zeigte sich in den verschiedenen Modellsituationen zwischen 50 und 100 Operationen/Jahr. Bei 100 navigierten Knie-TEP/Jahr, einer zusätzlichen Operationszeit von 14 min und Abschreibung der Investitionskosten über 10 Jahre betragen die Zusatzkosten je nach Navigationssystem von 300–395 €/Operation.

Schlussfolgerung

Die computerassistierte Navigation bei Knietotalendoprothesen ist mit Zusatzkosten verbunden. Unter ökonomischen Gesichtspunkten erscheint eine Anzahl von >50 navigierten Knie-TEP/Jahr sinnvoll. Die Kosteneffektivität kann erst abgeschätzt werden, wenn Langzeitergebnisse eine tatsächliche Reduktion der Revisionen oder ein verbessertes klinisches Ergebnis zeigen.

Abstract

Background

Total knee arthroplasty (TKA) is one of the most frequent procedures in orthopaedic surgery. The outcome depends on a range of factors including alignment of the leg and the positioning of the implant in addition to patient-associated factors. Computer-assisted navigation systems can improve the restoration of a neutral leg alignment. This procedure has been established especially in Europe and North America. The additional expenses are not reimbursed in the German DRG system (Diagnosis Related Groups). In the present study a cost analysis of computer-assisted TKA compared to the conventional technique was performed.

Methods

The acquisition expenses of various navigation systems (5 and 10year depreciation), annual costs for maintenance and software updates as well as the accompanying costs per operation (consumables, additional operating time) were considered. The additional operating time was determined on the basis of a meta-analysis according to the current literature. Situations with 25, 50, 100, 200 and 500 computer-assisted TKAs per year were simulated.

Results

The amount of the incremental costs of the computer-assisted TKA depends mainly on the annual volume and the additional operating time. A relevant decrease of the incremental costs was detected between 50 and 100 procedures per year. In a model with 100 computer-assisted TKAs per year an additional operating time of 14 mins and a 10 year depreciation of the investment costs, the incremental expenses amount to € 300-395 depending on the navigation system.

Conclusions

Computer-assisted TKA is associated with additional costs. From an economical point of view an amount of more than 50 procedures per year appears to be favourable. The cost-effectiveness could be estimated if long-term results will show a reduction of revisions or a better clinical outcome.

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  1. Klinik und Poliklinik für Orthopädie, Universitätsklinikum Carl Gustav Carus, Technische Universität, Fetscherstraße 74, 01307, Dresden, Deutschland

    O. Cerha, S. Kirschner, K.-P. Günther & J. Lützner

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  1. O. Cerha
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  2. S. Kirschner
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  4. J. Lützner
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Cerha, O., Kirschner, S., Günther, KP. et al. Kostenanalyse zur Navigation in der Knieendoprothetik. Orthopäde 38, 1235–1240 (2009). https://doi.org/10.1007/s00132-009-1473-z

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