RT Journal Article
SR Electronic
T1 ACL reconstruction for all is not cost-effective after acute ACL rupture
JF British Journal of Sports Medicine
JO Br J Sports Med
FD BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine
SP 24
OP 28
DO 10.1136/bjsports-2020-102564
VO 56
IS 1
A1 Vincent Eggerding
A1 Max Reijman
A1 Duncan Edward Meuffels
A1 Eline van Es
A1 Ewoud van Arkel
A1 Igor van den Brand
A1 Joost van Linge
A1 Jacco Zijl
A1 Sita MA Bierma-Zeinstra
A1 Marc Koopmanschap
YR 2022
UL http://bjsm.bmj.com/content/56/1/24.abstract
AB 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.Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. We agree on data sharing to British Journal of Sports Medicine when required according to the World Health Organization and Nordic Trial Alliance declaration about clinical trial transparency.