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Review
. 2011 Nov 19:11:317.
doi: 10.1186/1472-6963-11-317.

Reconstruction versus conservative treatment after rupture of the anterior cruciate ligament: cost effectiveness analysis

Mazda Farshad  1 , Christian Gerber, Dominik C Meyer, Alexander Schwab, Patricia R Blank, Thomas Szucs
Affiliations
Review

Reconstruction versus conservative treatment after rupture of the anterior cruciate ligament: cost effectiveness analysis

Mazda Farshad et al. BMC Health Serv Res. .

Abstract

Background: The decision whether to treat conservatively or reconstruct surgically a torn anterior cruciate ligament (ACL) is an ongoing subject of debate. The high prevalence and associated public health burden of torn ACL has led to continuous efforts to determine the best therapeutic approach. A critical evaluation of benefits and expenditures of both treatment options as in a cost effectiveness analysis seems well-suited to provide valuable information for treating physicians and healthcare policymakers.

Methods: A literature review identified four of 7410 searched articles providing sufficient outcome probabilities for the two treatment options for modeling. A transformation key based on the expert opinions of 25 orthopedic surgeons was used to derive utilities from available evidence. The cost data for both treatment strategies were based on average figures compiled by Orthopaedic University Hospital Balgrist and reinforced by Swiss national statistics. A decision tree was constructed to derive the cost-effectiveness of each strategy, which was then tested for robustness using Monte Carlo simulation.

Results: Decision tree analysis revealed a cost effectiveness of 16,038 USD/0.78 QALY for ACL reconstruction and 15,466 USD/0.66 QALY for conservative treatment, implying an incremental cost effectiveness of 4,890 USD/QALY for ACL reconstruction. Sensitivity analysis of utilities did not change the trend.

Conclusion: ACL reconstruction for reestablishment of knee stability seems cost effective in the Swiss setting based on currently available evidence. This, however, should be reinforced with randomized controlled trials comparing the two treatment strategies.

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Figures

Figure 1
Figure 1
Reviewing process of currently available literature to filter studies with direct comparison of conservative and surgical treatment and sufficient information on activity levels.
Figures 2
Figures 2
The cost-effectiveness acceptability frontier shows the probabilistic sensitivity analysis-based on the probability of surgically and conservatively treated ACL patients of being cost-effective. For different willingness to pay thresholds, a different strategy is preferred. For each threshold, only the probability for the optimal strategy is shown.
Figure 3
Figure 3
The cost-effectiveness scatter plot uses the cost-effectiveness plane to plot the cost and effectiveness pair for each recalculation of the model with 10,000 runs for each strategy.
See this image and copyright information in PMC

References

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