Cost-effectiveness analysis of surgical versus non-surgical management of acute Achilles tendon ruptures
| Autor: | Mikael Svensson, Nicklas Olsson, Jon Karlsson, Katarina Nilsson Helander, Olof Westin, Elisabeth Hansson Olofsson, Kristian Samuelsson, Karin Grävare Silbernagel |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Cost-Benefit Analysis Achilles Tendon HRQoL 03 medical and health sciences Indirect costs Young Adult QALY 0302 clinical medicine Quality of life Recurrence Tendon Injuries Surgical Health care Medicine Humans Orthopedics and Sports Medicine Patient Reported Outcome Measures Aged Rupture Achilles tendon rupture 030222 orthopedics Achilles tendon business.industry ICER 030229 sport sciences Cost-effectiveness analysis Middle Aged Sensitivity analyses Treatment medicine.anatomical_structure Non-surgical Orthopedic surgery Sick leave Physical therapy Quality of Life Surgery Female Quality-Adjusted Life Years medicine.symptom Ankle business Follow-Up Studies |
| Zdroj: | Knee Surgery, Sports Traumatology, Arthroscopy |
| ISSN: | 1433-7347 |
| Popis: | Purpose An Achilles tendon rupture is a common injury that typically affects people in the middle of their working lives. The injury has a negative impact in terms of both morbidity for the individual and the risk of substantial sick leave. The aim of this study was to investigate the cost-effectiveness of surgical compared with non-surgical management in patients with an acute Achilles tendon rupture. Methods One hundred patients (86 men, 14 women; mean age, 40 years) with an acute Achilles tendon rupture were randomised (1:1) to either surgical treatment or non-surgical treatment, both with an accelerated rehabilitation protocol (surgical n = 49, non-surgical n = 51). One of the surgical patients was excluded due to a partial re-rupture and five surgical patients were lost to the 1-year economic follow-up. One patient was excluded due to incorrect inclusion and one was lost to the 1-year follow-up in the non-surgical group. The cost was divided into direct and indirect costs. The direct cost is the actual cost of health care, whereas the indirect cost is the production loss related to the impact of the patient’s injury in terms of lost ability to work. The health benefits were assessed using quality-adjusted life years (QALYs). Sampling uncertainty was assessed by means of non-parametric boot-strapping. Results Pre-injury, the groups were comparable in terms of demographic data and health-related quality of life (HRQoL). The mean cost of surgical management was €7332 compared with €6008 for non-surgical management (p = 0.024). The mean number of QALYs during the 1-year time period was 0.89 and 0.86 in the surgical and non-surgical groups respectively. The (incremental) cost-effectiveness ratio was €45,855. Based on bootstrapping, the cost-effectiveness acceptability curve shows that the surgical treatment is 57% likely to be cost-effective at a threshold value of €50,000 per QALY. Conclusions Surgical treatment was more expensive compared with non-surgical management. The cost-effectiveness results give a weak support (57% likelihood) for the surgical treatment to be cost-effective at a willingness to pay per QALY threshold of €50,000. This is support for surgical treatment; however, additionally cost-effectiveness studies alongside RCTs are important to clarify which treatment option is preferred from a cost-effectiveness perspective. Level of evidence I. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full text from SpringerLink