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J Bone Joint Surg Am. 2013 Oct 2;95(19):1751-9. doi: 10.2106/JBJS.L.01705.
An anterior cruciate ligament (ACL) tear is a common knee injury, particularly among young and active individuals. Little is known, however, about the societal impacts of ACL tears, which could be large given the typical patient age and increased lifetime risk of knee osteoarthritis. This study evaluates the cost-effectiveness of ACL reconstruction compared with structured rehabilitation only.
A cost-utility analysis of ACL reconstruction compared with structured rehabilitation only was conducted with use of a Markov decision model over two time horizons: the short to intermediate term (six years), on the basis of Level-I evidence derived from the KANON Study and the Multicenter Orthopaedic Outcomes Network (MOON) database; and the lifetime, on the basis of a comprehensive literature review. Utilities were assessed with use of the SF-6D. Costs (in 2012 U.S. dollars) were estimated from the societal perspective and included the effects of the ACL tear on work status, earnings, and disability. Effectiveness was expressed as quality-adjusted life years (QALYs) gained.
In the short to intermediate term, ACL reconstruction was both less costly (a cost reduction of $4503) and more effective (a QALY gain of 0.18) compared with rehabilitation. In the long term, the mean lifetime cost to society for a typical patient undergoing ACL reconstruction was $38,121 compared with $88,538 for rehabilitation. ACL reconstruction resulted in a mean incremental cost savings of $50,417 while providing an incremental QALY gain of 0.72 compared with rehabilitation. Effectiveness gains were driven by the higher probability of an unstable knee and associated lower utility in the rehabilitation group. Results were most sensitive to the rate of knee instability after initial rehabilitation.
ACL reconstruction is the preferred cost-effective treatment strategy for ACL tears and yields reduced societal costs relative to rehabilitation once indirect cost factors, such as work status and earnings, are considered. The cost of an ACL tear over the lifetime of a patient is substantial, and resources should be directed to developing innovations for injury prevention and for altering the natural history of an ACL injury.
前交叉韧带（ACL）撕裂是一种常见的膝关节损伤，尤其在年轻和活跃的人群中更为常见。然而，对于 ACL 撕裂的社会影响知之甚少，鉴于典型的患者年龄和膝关节骨关节炎终生风险增加，其影响可能很大。本研究评估了 ACL 重建与单纯结构康复相比的成本效益。
采用 Markov 决策模型，基于 KANON 研究和多中心骨科结果网络（MOON）数据库的一级证据，对 ACL 重建与单纯结构康复进行了短期到中期（六年）的成本效用分析；并基于全面的文献综述，对终生进行了成本效用分析。使用 SF-6D 评估效用。从社会角度估算成本（2012 年美元），并包括 ACL 撕裂对工作状态、收入和残疾的影响。有效性用质量调整生命年（QALY）表示。
在短期到中期，ACL 重建既更具成本效益（节省 4503 美元），又更有效（增加 0.18 个 QALY），优于康复。在长期，接受 ACL 重建的典型患者的社会终生平均成本为 38121 美元，而康复的成本为 88538 美元。ACL 重建的增量成本节约为 50417 美元，而与康复相比，增加的 QALY 为 0.72。有效性的提高是由康复组膝关节不稳定的可能性更高以及相关的效用更低所驱动的。结果对初始康复后膝关节不稳定的发生率最为敏感。
ACL 重建是 ACL 撕裂的首选成本效益治疗策略，与康复相比，在考虑间接成本因素（如工作状态和收入）后，可降低社会成本。患者一生中 ACL 撕裂的成本相当大，资源应用于开发预防损伤的创新技术和改变 ACL 损伤的自然病史。
