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

Autor: Deviandri R; Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. r.deviandri@rug.nl.; Department of Surgery-Faculty of Medicine, Universitas Riau, Arifin Achmad Hospital, Diponegoro street no 1, Pekanbaru, 28133, Indonesia. r.deviandri@rug.nl.; Division of Orthopedics-Sports Injury, Fit Centre Institute, Pekanbaru, Indonesia. r.deviandri@rug.nl., van der Veen HC; Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Purba AKR; Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia., Icanervilia AV; Department of Radiology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia., Lubis AM; Department of Orthopedics-Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia., van den Akker-Scheek I; Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Postma MJ; Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.; Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands.; Department of Pharmacology & Therapy, Universitas Airlangga, Surabaya, Indonesia.; Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia.
Jazyk: angličtina
Zdroj: BMC health services research [BMC Health Serv Res] 2024 Jul 09; Vol. 24 (1), pp. 784. Date of Electronic Publication: 2024 Jul 09.
DOI: 10.1186/s12913-024-11212-8
Abstrakt: 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.
(© 2024. The Author(s).)
Databáze: MEDLINE
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