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Published on: April 30, 2014
Cost-effectiveness of anterior cruciate ligament reconstruction: a preliminary comparison of single-bundle and
E Scott Paxton1, Steven M Kymes, Robert H Brophy
1Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA.
Background:
There has been growing interest in anatomical reconstruction of the anterior cruciate ligament (ACL), including the use of double-bundle (DB) reconstruction techniques.
Hypothesis:
The DB technique will not be cost-effective when compared with single-bundle (SB) reconstruction.
Study Design:
Economic and decision analysis; Level of evidence, 1.
Methods:
A decision-analysis model with input values derived from the literature was used to estimate the cost-effectiveness of DB ACL reconstruction compared with SB ACL reconstruction. Effectiveness was based on the revision rate and the postoperative International Knee Documentation Committee (IKDC) score.
Results:
Sixty-four percent of DB knees result in an IKDC score of A, compared with 54% of SB knees. The incremental cost-effectiveness ratio of a DB reconstruction compared with an SB reconstruction was $6416 per quality adjusted life year in the baseline scenario and $64 371 per quality adjusted life year in the alternate scenario. The model is very sensitive to the proportions of IKDC A outcomes. The model is also sensitive to the utility values assigned to IKDC A and B outcomes and is less sensitive to the marginal cost of a DB reconstruction.
Conclusion:
This preliminary analysis based on published clinical results to date shows DB ACL reconstruction may be cost-effective, despite increased upfront cost. More research is needed to confirm whether there is any difference in the distribution of IKDC outcomes between the 2 techniques. Perhaps more importantly, the lack of any other demonstrated clinical benefit from the DB technique questions the clinical relevance of this difference in IKDC scores.
Clinical Relevance:
Revision data and longer term outcomes after DB reconstruction and more reliable clinical utility data are needed to definitively compare the cost-effectiveness of DB and SB ACL reconstruction. Studies of ACL reconstruction and other sports medicine procedures should report the distribution of outcomes data to facilitate future analyses of clinical effectiveness.