Cost analysis of converting from single-bundle to double-bundle anterior cruciate ligament reconstruction

Abstract

Background: Recent studies comparing double-bundle anterior cruciate ligament reconstruction to single-bundle anterior cruciate ligament reconstruction have reported some biomechanical advantages but little or no short-term clinical benefit from the double-bundle technique. In the current healthcare environment, the potential economic implications of widespread conversion to a double-bundle anterior cruciate ligament reconstruction are an important consideration.

Purpose: To determine the economic implications of widespread use of the double-bundle technique for anterior cruciate ligament reconstruction.

Study design: Economic analysis; Level of evidence, 2.

Methods: A cost model to assess the effect of double-bundle anterior cruciate ligament reconstruction was constructed using standard accounting methodology. The model was based on actual 2008 cost figures (in US dollars) for ligamentous allografts, fixation implants, and operating room time. Revision rate (4%) and time to revision surgery (mean, 4 years) for single-bundle anterior cruciate ligament reconstruction was based on the available literature. Assumptions about the prevalence of double-bundle versus single-bundle anterior cruciate ligament reconstruction, the number of grafts used, and the revision rate for double-bundle reconstruction were varied to assess their effect on cost.

Results: The potential additional cost for widespread conversion to the double-bundle technique for anterior cruciate ligament reconstruction ranges from $36 million to $792 million per year in the United States alone. To offset this increased cost, the double-bundle technique would have to reduce the revision rate at a minimum from 4% to 1.5% and potentially from 24.1% to 0%.

Conclusion: Double-bundle anterior cruciate ligament reconstruction has the potential of adding considerable cost to the health-care system.

Clinical relevance: While further research is warranted to determine if there are other benefits from this technique, widespread adoption of a double-bundle anterior cruciate ligament reconstruction does not appear to be cost-effective at this time.