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Does prevention pay off? Economic aspects of sports injury prevention: a systematic review
  1. Christoph Lutter1,
  2. Christophe Jacquet2,3,
  3. Evert Verhagen4,
  4. Romain Seil2,3,
  5. Thomas Tischer1
  1. 1 Department of Orthopedics, University Medical Center Rostock, Rostock, Germany
  2. 2 Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d'Eich, Luxembourg, Luxembourg
  3. 3 Luxembourg Institute of Health, Luxembourg, Luxembourg
  4. 4 Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, University Medical Centers – Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
  1. Correspondence to Dr Christoph Lutter, Department of Orthopaedic Surgery, Rostock University Medical Center, Rostock 18057, Germany; christoph.lutter{at}


Objective To identify, summarise and critically assess economic evaluation studies on sports injury prevention strategies.

Design Systematic review.

Data sources PubMed, SportDiscuss.

Eligibility criteria for selecting studies The current literature was searched following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Economic analyses published since 2010 were checked for inclusion. The methodological quality of the studies was assessed using the Oxford Level of Evidence for economic and decision analysis; underlying randomised controlled trials (RCTs) were rated according to the Physiotherapy Evidence Database (PEDro) Scale, and risk of bias was assessed using the Revised Cochrane risk-of-bias tool.

Results Ten studies fulfilled the inclusion criteria. The quality assessment revealed limited data quality. For trial-based analysis, underlying RCTs were of good quality and had a low risk of bias. Prevention concepts for general injury reduction showed effectiveness and cost savings. Regarding specific injury types, the analysis of the studies showed that the best data are available for ankle, hamstring and anterior cruciate ligament injuries. Measures using specific training interventions were the predominant form of prevention concepts; studies investigating these concepts showed cost-effectiveness with total cost savings between €24.82 and €462 per athlete.

Conclusion Injury prevention strategies that were studied are cost-effective. However, estimates and outcomes vary throughout the included studies, and precluded pooling of existing data. Knowledge about the cost-effectiveness of evaluated prevention measures will help improve the acceptance and application of prevention initiatives.

  • football
  • anterior cruciate ligament
  • olympics
  • economics
  • injury prevention

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  • Contributors Study design, monitoring of data collection and analysis, interpretation of data, drafting and final approval of the manuscript: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.