Dataset Information

Cost-utility analysis of early reconstruction surgery versus conservative treatment for anterior cruciate ligament injury in a lower-middle income country.

ABSTRACT:

Background

The ideal approach for treating anterior cruciate ligament (ACL) injury is still disputed. This study aimed to determine the more cost-effective strategy by comparing early ACL reconstruction (ACLR) surgery to conservative treatment (rehabilitation with optional delayed reconstruction) for ACL injury in a lower/middle-income country (LMIC), Indonesia.

Methods

A decision tree model was constructed for cost-utility analysis of early ACLR versus conservative treatment. The transition probabilities between states were obtained from the literature review. Utilities were measured by the EQ-5D-3 L from a prospective cohort study in a local hospital. The costs were obtained from a previous study that elaborated on the burden and cost of ACLR in Indonesia. Effectiveness was expressed in quality-adjusted life years gained (QALYs). Principal outcome measure was the incremental cost-effectiveness ratios (ICER). Willingness-to-pay was set at US$12,876 - three times the Indonesian GDP per capita in 2021 - the currently accepted standard in Indonesia as suggested by the World Health Organization Choosing Interventions that are Cost-Effective criterion (WHO-CHOICE).

Results

The early ACLR group showed an incremental gain of 0.05 QALYs over the conservative treatment group, with a higher overall cost to society of US$976. The ICER of ACLR surgery was US$19,524 per QALY, above the WTP threshold of US$12,876. The ICER was sensitive to cost of conservative treatment, cost of ACLR, and rate of cross-over to delayed ACLR numbers in the conservative treatment group. Using the WTP threshold of US$12,876, the probability of conservative treatment being preferred over early ACLR was 64%.

Conclusions

Based on the current model, early ACLR surgery does not seem more cost-effective compared to conservative treatment for ACL injury patients in Indonesia. Because the result was sensitive to the rate of cross-over probabilities from the conservative treatment alone to delayed ACLR, a future study with a long-term perspective is needed to further elucidate its impact.

SUBMITTER: Deviandri R

PROVIDER: S-EPMC11234700 | biostudies-literature | 2024 Jul

REPOSITORIES: biostudies-literature

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Publications

Cost-utility analysis of early reconstruction surgery versus conservative treatment for anterior cruciate ligament injury in a lower-middle income country.

Deviandri Romy R van der Veen Hugo C HC Purba Abdul Khairul R AKR Icanervilia Ajeng V AV Lubis Andri Mt AM van den Akker-Scheek Inge I Postma Maarten J MJ

BMC health services research 20240709 1

<h4>Background</h4>The ideal approach for treating anterior cruciate ligament (ACL) injury is still disputed. This study aimed to determine the more cost-effective strategy by comparing early ACL reconstruction (ACLR) surgery to conservative treatment (rehabilitation with optional delayed reconstruction) for ACL injury in a lower/middle-income country (LMIC), Indonesia.<h4>Methods</h4>A decision tree model was constructed for cost-utility analysis of early ACLR versus conservative treatment. The ...[more]

PMID: 38982438

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Project description:BackgroundChanges in lower limb joint coordination have been shown to increase localized stress on knee joint soft tissue-a known precursor of osteoarthritis. While 50% of individuals who undergo anterior cruciate ligament reconstruction (ACLR) develop radiographic osteoarthritis, it is unclear how underlying joint coordination during gait changes post-ACLR. The purpose of this study was twofold: to determine differences in lower limb coordination patterns during gait in ACLR individuals 2, 4, and 6 months post-ACLR and to compare the coordination profiles of the ACLR participants at each timepoint post-ACLR to uninjured matched controls.MethodsWe conducted a longitudinal assessment to quantify lower limb coordination at 3 timepoints post-ACLR and compared the ACLR coordination profiles to uninjured controls. Thirty-four ACLR (age = 21.43 ± 4.24 years, mean ± SD; 70.59 % female) and 34 controls (age = 21.42 ± 3.43 years; 70.59% female) participated. The ACLR group completed 3 overground gait assessments (2,4, and 6 months post-ACLR), and the controls completed one assessment, at which lower limb kinematics were collected. Cross-recurrence quantification analysis was used to characterize sagittal and frontal plane ankle-knee, ankle-hip, and knee-hip coordination dynamics. Comprehensive general linear mixed models were constructed to compare between-limb and within-limb coordination outcomes over time post-ACLR and a between-group comparison across timepoints.ResultsThe ACLR limb demonstrated a more "stuck" sagittal plane knee-hip coordination profile (greater trapping time (TT); p = 0.004) compared bilaterally. Between groups, the ACLR participants exhibited a more predictable ankle-knee coordination pattern (percent determinism (%DET); p < 0.05), stronger coupling between joints (meanline (MNLine)) across all segments (p < 0.05), and greater knee-hip TT (more "stuck"; p < 0.05) compared to the controls at each timepoint in the sagittal plane. Stronger frontal plane knee-hip joint coupling (MNLine) persisted across timepoints within the ACLR group compared to the controls (p < 0.05).ConclusionThe results indicate ACLR individuals exhibit a distinct and rigid coordination pattern during gait compared to controls within 6-month post-ACLR, which may have long-term implications for knee-joint health.

Dataset Information

Cost-utility analysis of early reconstruction surgery versus conservative treatment for anterior cruciate ligament injury in a lower-middle income country.

Background

Methods

Results

Conclusions

Publications

Cost-utility analysis of early reconstruction surgery versus conservative treatment for anterior cruciate ligament injury in a lower-middle income country.

Similar Datasets

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