The Cost-Effectiveness of Meniscal Repair Versus Partial Meniscectomy in the Setting of Anterior Cruciate Ligament Reconstruction
| Autor: | Jonathan D. Lester, Susan M. Odum, Jacob D. Gorbaty, James E. Fleischli, Mark E. Rogers |
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| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Anterior cruciate ligament reconstruction Cost effectiveness medicine.medical_treatment Anterior cruciate ligament Cost-Benefit Analysis Knee replacement Osteoarthritis Decision Support Techniques 03 medical and health sciences 0302 clinical medicine medicine Humans Orthopedics and Sports Medicine Meniscus repair health care economics and organizations Meniscectomy 030222 orthopedics Anterior Cruciate Ligament Reconstruction business.industry 030229 sport sciences musculoskeletal system medicine.disease United States Surgery Meniscal repair Quality-adjusted life year Tibial Meniscus Injuries medicine.anatomical_structure Quality-Adjusted Life Years business |
| Zdroj: | Arthroscopy : the journal of arthroscopicrelated surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 34(9) |
| ISSN: | 1526-3231 |
| Popis: | Purpose To compare the cost-effectiveness of anterior cruciate ligament (ACL) reconstruction with meniscal repair to ACL reconstruction with partial meniscectomy. Methods A decision-analytic Markov disease progression model with a 40-year horizon was created simulating outcomes after both meniscal repair and partial meniscectomy at the time of ACL reconstruction. Event probabilities, costs, and utilities were used for the index procedures. The development of osteoarthritis and subsequent knee replacement were either calculated or selected from published literature. Difference in cost, difference in quality-adjusted life-years (QALYs), and incremental cost-effective ratio were calculated to determine which index procedure is most cost-effective. Results There is total direct cost from ACL reconstruction with meniscus repair of $17,898 compared with that with partial meniscectomy of $24,768 (cost savings of $6,870). There was an estimated gain of 18.00 QALYs after ACL reconstruction with meniscus repair compared with 17.16 QALYs with partial meniscectomy (increase of 0.84 QALYs). In this scenario, meniscus repair is the dominant index procedure at the time of ACL reconstruction. Conclusions Meniscal repair at the time of ACL reconstruction is more cost-effective than partial meniscectomy. Level of Evidence Level IV, economic and decision analysis. |
| Databáze: | OpenAIRE |
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