Sports Medicine Center, OrthoCarolina, Charlotte, North Carolina, U.S.A.
Department of Orthopedic Surgery, Carolinas Medical Center, Charlotte, North Carolina, U.S.A..
Arthroscopy. 2018 Sep;34(9):2614-2620. doi: 10.1016/j.arthro.2018.06.046.
To compare the cost-effectiveness of anterior cruciate ligament (ACL) reconstruction with meniscal repair to ACL reconstruction with partial meniscectomy.
A decision-analytic Markov disease progression model with a 40-year horizon was created simulating outcomes after both meniscal repair and partial meniscectomy at the time of ACL reconstruction. Event probabilities, costs, and utilities were used for the index procedures. The development of osteoarthritis and subsequent knee replacement were either calculated or selected from published literature. Difference in cost, difference in quality-adjusted life-years (QALYs), and incremental cost-effective ratio were calculated to determine which index procedure is most cost-effective.
There is total direct cost from ACL reconstruction with meniscus repair of $17,898 compared with that with partial meniscectomy of $24,768 (cost savings of $6,870). There was an estimated gain of 18.00 QALYs after ACL reconstruction with meniscus repair compared with 17.16 QALYs with partial meniscectomy (increase of 0.84 QALYs). In this scenario, meniscus repair is the dominant index procedure at the time of ACL reconstruction.
Meniscal repair at the time of ACL reconstruction is more cost-effective than partial meniscectomy.
Level IV, economic and decision analysis.
比较前交叉韧带（ACL）重建伴半月板修复与 ACL 重建伴半月板部分切除术的成本效益。
创建了一个具有 40 年时间范围的决策分析马尔可夫疾病进展模型，模拟了 ACL 重建时半月板修复和半月板部分切除后的结果。指数手术采用事件概率、成本和效用。骨关节炎的发展和随后的膝关节置换术要么是通过计算得出的，要么是从已发表的文献中选择的。计算了成本差异、质量调整生命年（QALY）差异和增量成本效益比，以确定哪种指数手术最具成本效益。
ACL 重建伴半月板修复的总直接成本为 17898 美元，而 ACL 重建伴半月板部分切除术为 24768 美元（节省成本 6870 美元）。ACL 重建伴半月板修复后估计获得的 QALY 为 18.00，而 ACL 重建伴半月板部分切除术为 17.16（增加 0.84 QALY）。在此情况下，ACL 重建时半月板修复是更具成本效益的指数手术。
ACL 重建时半月板修复比半月板部分切除术更具成本效益。
IV 级，经济和决策分析。
