Societal and Economic Impact of Anterior Cruciate Ligament Tears
Societal and Economic Impact of Anterior Cruciate Ligament Tears
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DOI：
10.2106/jbjs.l.01705
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发表时间：
2013-10-02
影响因子：
5.3
通讯作者：
Spindler, Kurt P.
中科院分区：
文献类型：
--
作者：
Mather, Richard C., III;Koenig, Lane;Spindler, Kurt P.
背景：前交叉韧带（ACL）撕裂是一种常见的膝关节损伤，尤其是在年轻和活跃的人群中。然而，人们对ACL撕裂的社会影响知之甚少，考虑到典型的患者年龄和膝关节骨关节炎的终身风险增加，ACL撕裂的社会影响可能很大。本研究评估ACL重建与结构化康复相比的成本效益。方法：ACL重建与结构化康复相比的成本效益分析在两个时间范围内进行：短期到中期（6年），基于KANON研究和多中心骨科结局网络（MOON）数据库得出的I级证据;和寿命，在全面的文献综述的基础上。使用SF-6D评估效用。从社会角度估计成本（2012年美元），包括ACL撕裂对工作状态、收入和残疾的影响。有效性表示为质量调整生命年（QALY）gained.Results：在短期到中期，ACL重建是既便宜（成本降低4503美元）和更有效（QALY增益0.18）相比，康复。从长远来看，接受ACL重建的典型患者的平均终身社会成本为38，121美元，而康复为88，538美元。ACL重建导致平均增量成本节省50，417美元，同时与康复相比，提供了0.72的增量QALY增益。康复组中膝关节不稳定的可能性更高，相关的效用更低，这推动了有效性的提高。结果是最敏感的膝关节不稳定率后，初步rehabilitation.Conclusions：ACL重建是首选的成本效益的治疗策略ACL撕裂和产量减少社会成本相对于康复一旦间接成本因素，如工作状态和收入，被认为是。ACL撕裂在患者的一生中的成本是巨大的，资源应该被引导到开发损伤预防和改变ACL损伤的自然史的创新。
Background: 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.Methods: 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.Results: 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.Conclusions: 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.