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Randomized Controlled Trial
. 2022 Jan;56(1):24-28.
doi: 10.1136/bjsports-2020-102564. Epub 2021 Mar 18.

ACL reconstruction for all is not cost-effective after acute ACL rupture

Vincent Eggerding  1 , Max Reijman  2 , Duncan Edward Meuffels  2 , Eline van Es  2 , Ewoud van Arkel  3 , Igor van den Brand  4 , Joost van Linge  5 , Jacco Zijl  6 , Sita Ma Bierma-Zeinstra  7 , Marc Koopmanschap  8
Affiliations
Randomized Controlled Trial

ACL reconstruction for all is not cost-effective after acute ACL rupture

Vincent Eggerding et al. Br J Sports Med. 2022 Jan.

Abstract

Objectives: To conduct a cost-utility analysis for two commonly used treatment strategies for patients after ACL rupture; early ACL reconstruction (index) versus rehabilitation plus an optional reconstruction in case of persistent instability (comparator).

Methods: Patients aged between 18 and 65 years of age with a recent ACL rupture (<2 months) were randomised between either an early ACL reconstruction (index) or a rehabilitation plus an optional reconstruction in case of persistent instability (comparator) after 3 months of rehabilitation. A cost-utility analysis was performed to compare both treatments over a 2-year follow-up. Cost-effectiveness was calculated as incremental costs per quality-adjusted life year (QALY) gained, using two perspectives: the healthcare system perspective and societal perspective. The uncertainty for costs and health effects was assessed by means of non-parametric bootstrapping.

Results: A total of 167 patients were included in the study, of which 85 were randomised to the early ACL reconstruction (index) group and 82 to the rehabilitation and optional reconstruction group (comparator). From the healthcare perspective it takes 48 460 € and from a societal perspective 78 179 €, to gain a QALY when performing early surgery compared with rehabilitation plus an optional reconstruction. This is unlikely to be cost-effective.

Conclusion: Routine early ACL reconstruction (index) is not considered cost-effective as compared with rehabilitation plus optional reconstruction for a standard ACL population (comparator) given the maximum willingness to pay of 20 000 €/QALY. Early recognition of the patients that have better outcome of early ACL reconstruction might make rehabilitation and optional reconstruction even more cost-effective.

Keywords: anterior cruciate ligament; exercise rehabilitation; knee injuries; knee surgery; sports rehabilitation programs.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Quality of life (EQ-5D) on the different time points (months).
Figure 2
Figure 2
Cost-effectiveness plane and acceptability curve from the healthcare system perspective. ICER, incremental cost-effectiveness ratio. Costs in euros and valued for 2018.
Figure 3
Figure 3
Cost-effectiveness plane and acceptability curve from the healthcare system perspective. ICER, incremental cost-effectiveness ratio. Costs in euros and valued for 2018.
See this image and copyright information in PMC

References

    1. Filbay SR, Culvenor AG, Ackerman IN, et al. . Quality of life in anterior cruciate ligament-deficient individuals: a systematic review and meta-analysis. Br J Sports Med 2015;49:1033–41. 10.1136/bjsports-2015-094864 - DOI - PubMed
    1. Cameron KL, Thompson BS, Peck KY, et al. . Normative values for the KOOS and WOMAC in a young athletic population: history of knee ligament injury is associated with lower scores. Am J Sports Med 2013;41:582–9. 10.1177/0363546512472330 - DOI - PubMed
    1. Meuffels DE. [Increase in surgical treatment of anterior cruciate ligament injury]. Ned Tijdschr Geneeskd 2009;153:A466. - PubMed
    1. draaitabel MSZ vj 2018 [Internet] 2018.
    1. Frobell RB, Roos EM, Roos HP, et al. . A randomized trial of treatment for acute anterior cruciate ligament tears. N Engl J Med 2010;363:331–42. 10.1056/NEJMoa0907797 - DOI - PubMed

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