Orthopedics, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
Orthopedics, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands.
Br J Sports Med. 2022 Jan;56(1):24-28. doi: 10.1136/bjsports-2020-102564. Epub 2021 Mar 18.
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).
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.
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.
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.
对两种常用于 ACL 撕裂后患者的治疗策略进行成本效用分析；即早期 ACL 重建（指数）与康复加必要时行 ACL 重建（对照）。
将年龄在 18 至 65 岁之间、ACL 近期撕裂（<2 个月）的患者随机分为早期 ACL 重建（指数）或康复加必要时行 ACL 重建（对照）组。在 3 个月的康复治疗后，对两种治疗方法进行了为期 2 年的随访。从医疗保健系统和社会角度，采用增量成本效益比（ICER），对两种治疗方案进行成本效用分析。使用非参数自举法评估成本和健康效果的不确定性。
共有 167 例患者入组，其中 85 例随机分配至早期 ACL 重建（指数）组，82 例随机分配至康复加必要时行 ACL 重建组（对照）。从医疗保健系统角度来看，早期手术与康复加必要时行 ACL 重建相比，获得 1 个质量调整生命年（QALY）需要花费 48460 欧元，从社会角度来看，需要花费 78179 欧元。这不太可能具有成本效益。
鉴于 20000 欧元/QALY 的最大意愿支付值，对于标准 ACL 人群（对照），与康复加必要时行 ACL 重建相比，常规早期 ACL 重建（指数）并不被认为具有成本效益。早期识别出早期 ACL 重建效果更好的患者，可能会使康复加必要时行 ACL 重建更具成本效益。
