Department of Orthopedic Surgery, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
BMC Health Serv Res. 2011 Nov 19;11:317. doi: 10.1186/1472-6963-11-317.
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.
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.
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.
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.
是选择保守治疗还是手术重建撕裂的前交叉韧带（ACL），这一直是一个争论的话题。ACL 撕裂的高发率及其对公共健康的影响，促使人们不断努力寻找最佳治疗方法。成本效益分析对两种治疗方案的效益和支出进行了批判性评估，似乎非常适合为治疗医生和医疗保健政策制定者提供有价值的信息。
文献检索共检索到 7410 篇文章，其中 4 篇文章提供了两种治疗方案的足够结局概率，可用于建模。使用基于 25 名骨科医生专家意见的转换键，从现有证据中得出效用值。两种治疗策略的成本数据基于巴格利斯特骨科大学医院（Orthopaedic University Hospital Balgrist）汇总的平均数据，并辅之以瑞士国家统计数据。构建决策树以推导出每种策略的成本效益，然后使用蒙特卡罗模拟进行稳健性测试。
决策树分析显示 ACL 重建的成本效益为 16038 美元/0.78 QALY，保守治疗的成本效益为 15466 美元/0.66 QALY，意味着 ACL 重建的增量成本效益为 4890 美元/QALY。效用的敏感性分析并未改变趋势。
基于目前可用的证据，在瑞士环境下，ACL 重建用于重建膝关节稳定性似乎具有成本效益。然而，这应该通过比较两种治疗策略的随机对照试验来加强。
