{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T09:39:23Z","timestamp":1789205963428,"version":"build-2803163510"},"reference-count":38,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ActaO"],"abstract":"<jats:p>Background and purpose:\u00a0Robotic-assisted total knee arthroplasty (RATKA) can enhance surgical precision. In middle-income countries (MICs), constrained fiscal space and the double burden of rising demand for high-cost technologies and competing public-health priorities\u2014unlike high-income countries with broader fiscal headroom and low-income countries with limited adoption of expensive innovations\u2014make adoption decisions for RATKA particularly challenging. We aimed to evaluate the cost-effectiveness analysis (using a cost-utility framework) of RATKA vs conventional TKA (COTKA) from a societal perspective in Thailand as a MIC.Methods:\u00a0A discrete event simulation model was employed to compare the cost-effectiveness of unilateral RATKA with COTKA over 4.5 years from a societal perspective, using patient-level data from January 2018 to June 2022 from an arthroplasty center in Thailand. Patients were propensity matched to balance comorbidities. Base case analysis assumed 1 robot performs 434 TKA cases per year with an anticipated lifespan of 12.5 years. We considered direct medical, non-medical, and indirect costs, alongside quality-adjusted life years (QALYs) gained from a societal perspective. We calculated incremental net monetary benefits (INMB) and cost-effectiveness ratios (ICERs) as the main outcome measures. Sensitivity analyses and 10 scenario analyses were performed exploring various possible settings. Threshold analyses determined combinations where RATKA could be cost-effective with positive INMB under the Thai cost-effectiveness threshold of US$4,888 per QALY gained.Results:\u00a0The base case analysis involved 157 COTKA and 1570 RATKA matched cases with a mean age of 69 (standard deviation 8 years). The lifetime average outcomes per patient were: COTKA\u2014US$5,031.9 and 9.07 QALYs; RATKA\u2014US$5,666.9 and 9.16 QALYs. The incremental (RATKA\u2013COTKA) differences were +US$633.6 (95% credible intervals [CrI] ~592\u2013675) and +0.085 QALYs (CrI ~0.04\u20130.13), yielding an ICER of US$7,436.6\/QALY. RATKA was not cost-effective compared with COTKA, with an INMB of \u2013216.9 US$\/patient. The probability of RATKA being cost-effective at the Thai cost-effectiveness threshold was 44.3%. For RATKA to be economically attractive, 1 robot must operate on at least 640 TKA cases\/year over 12.5 years. 3 scenarios found RATKA to be cost-effective: (i) maximal robot utilization (850 cases\/year); (ii) lowest capital costs (611,060 US$\/robot) with high efficacy for RATKA (hazard ratio [HR] 0.6); and (iii) extreme efficacy of RATKA in reducing complications (HR 0.024).Conclusion:\u00a0In the context of MIC, a broad adoption of RATKA is not economically attractive as treatment of end-stage knee osteoarthritis patients compared with COTKA.<\/jats:p>","DOI":"10.2340\/17453674.2025.44753","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T06:41:07Z","timestamp":1759300867000},"source":"Crossref","is-referenced-by-count":13,"title":["Cost-effectiveness of robotic-assisted versus conventional total knee arthroplasty: an analysis from a middle income country"],"prefix":"10.2340","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7041-3562","authenticated-orcid":false,"given":"Pakpoom","family":"Ruangsomboon","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Onlak","family":"Ruangsomboon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanrudee","family":"Isaranuwatchai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael G","family":"Zywiel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David MJ","family":"Naimark","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1183","published-online":{"date-parts":[[2025,9,30]]},"reference":[{"key":"128266","doi-asserted-by":"crossref","unstructured":"Evans J T, Walker R W, Evans J P, Blom A W, Sayers A, Whitehouse M R. 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