Abstract
ObjectivesThe aim of this study was to evaluate the cost-effectiveness of the dynamic intraligamentary stabilization (DIS) technique in comparison with reconstructive surgery (ACLR) in the treatment of isolated anterior cruciate ligament (ACL) ruptures from the perspective of the community of insured citizens in Germany.MethodsBecause of the specific decision problem at hand, namely that with DIS the procedure has to take place within 21 days after the initial trauma, a decision tree was developed.The time horizon of the model was set to 3 years. Input data was taken from official tariffs, payer data, the literature and assumptions based on expert opinion when necessary.ResultsThe decision tree analysis identified the DIS strategy as the superior one with 2.34 QALY versus 2.26 QALY for the ACLR branch. The higher QALY also came with higher costs of 5,398.05 € for the DIS branch versus 4,632.68 € for the ACLR branch respectively, leading to an ICER of 9,092.66 € per QALY. Results were robust after sensitivity analysis. Uncertainty was examined via probabilistic sensitivity analysis resulting in a slightly higher ICER of 9,567.13 € per QALY gained.ConclusionThe DIS technology delivers an effective treatment for the ACL rupture at a favorable incremental cost-effectiveness ratio.
Highlights
The main cause for a rupture of the anterior cruciate ligament (ACL) are non-contact injuries during football, basketball, soccer and downhill skiing [1]
The higher QALY came with higher costs of 5,398.05€ for the dynamic intraligamentary stabilization (DIS) branch and 4,632.68€ for the anterior cruciate ligament reconstructions (ACLR) branch respectively
The main influencing variables are the probability of revision surgery in the ACLR group and the costs associated with the removal of the DIS monobloc
Summary
The main cause for a rupture of the anterior cruciate ligament (ACL) are non-contact injuries during football, basketball, soccer and downhill skiing [1]. The US alone spend over $1 billion on anterior cruciate ligament reconstructions (ACLR) annually [2, 3]. In Germany more than 30,000 ACLs are reconstructed every year leading to about 113.3 Million € in hospital costs. The patient tries to compensate the instability caused by the torn ACL with muscular training. This treatment is considered suitable for older and/or less active people. The second strategy is early reconstructive surgery (ACLR in the model). Hereby the torn ligament is reconstructed as early as six weeks after the trauma [3]. For surgical reconstruction a variety of procedures and techniques (i.e. single bundle, double bundle, allo- or autograft)
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