Similar cost-utility for double- and single-bundle techniques in ACL reconstruction

Abstract

PurposeThe aim was to estimate the cost-utility of the DB technique (n = 53) compared with the SB (n = 50) technique 2 years after ACL reconstruction.MethodsOne hundred and five patients with an ACL injury were randomised to either the Double-bundle (DB) or the Single-bundle (SB) technique. One hundred and three patients (SBG n = 50, DBG n = 53) attended the 2-year follow-up examination. The mean age was 27.5 (8.4) years in the SBG and 30.1 (9.1) years in the DBG. The cost per quality-adjusted life years (QALYs) was used as the primary outcome. Direct costs were the cost of health care, in this case outpatient procedures. Indirect costs are costs related to reduce work ability for health reasons. The cost-utility analysis was measured in terms of QALY gained.ResultsThe groups were comparable in terms of clinical outcome. Operating room time was statistically significantly longer in the DBG (p = 0.001), making the direct costs statistically significantly higher in the DBG (p = 0.005). There was no significant difference in QALYs between groups. In the cost-effectiveness plane, the mean difference in costs and QALYs from the trial data using 1000 bootstrap replicates in order to visualise the uncertainty associated with the mean incremental cost-effectiveness ratio (ICER) estimate showed that the ICERs were spread out over all quadrants. The cost-effectiveness acceptability curve showed that there was a 50% probability of the DB being cost-effective at a threshold of Euro 50,000.ConclusionThe principal findings are that the DB is more expensive from a health-care perspective. This suggests that the physician may choose individualised treatment to match the patients’ expectations and requirements.

Long-term quality of life, work limitation, physical activity, economic cost and disease burden following ACL and meniscal injury: a systematic review and meta-analysis for the OPTIKNEE consensus

“…Common sources of bias included insufficient study power, loss to follow-up and not accounting for confounding. Of 15 randomised controlled trials (RCTs), 9 were low-RoB30 31 52–58 and 6 were susceptible-to-some bias16 17 59–62 (online supplemental appendix 4). Common sources of bias included a lack of blinding, no allocation concealment, insufficient sample size or inappropriate reporting of sample size.…”

“…HRQoL was evaluated with the SF-36,16 17 19 30 32 36 37 44 49 50 52 53 57 59–61 64–66 70 72–74 SF-12,15 18 33 38 43 56 68 Veterans RAND 12-Item Health Survey (VR-12),45 67 71 EQ-5D34 39 42 55 64 69 and AQoL-8D 8 35…”

Long term results after double and single bundle ACL reconstruction: Is there any difference? A meta - analysis of randomized controlled trials

“…Furthermore, the DB techniques require excellent surgical skills and a longer learning curve 46 . Given that the SB techniques yield similar efficacy with DB techniques in long-term follow-up and is more cost-effective,47, 48 the SB techniques may be more suitable as the standard techniques of ACL reconstruction.…”

Anterolateral Complex Reconstruction: Another Fad or Method to Improve ACL Outcomes?

“…More recently, Sernert and Hansson 54 conducted a full economic evaluation alongside a randomized trial comparing the single to DB-ACLR over 2 years of follow-up and found that although the DB technique had higher procedure-related costs, when they also accounted for productivity losses there were no significant difference in cost between the 2 groups. Therefore, they suggest that although DB-ACLR is likely not cost-effective from the health care perspective, it may be cost-effective compared with SB-ACLR from a societal perspective.…”