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Study finds knee arthroscopy, ACL reconstruction cost-effective
Lubowitz JH. Arthoscopy. 2011. doi:10.1016/j.arthro.2011.06.001
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Knee arthroscopy and ACL reconstruction are cost-effective, according to this retrospective analysis of prospectively collected data from researchers in New Mexico.
The team looked at data from a single-surgeon outcomes registry, analyzing one cohort of 93 patients with arthroscopically treated knees and one cohort of 35 patients who underwent ACL reconstructions. The outcome measure for the study was cost-effectiveness as determined by the cost of a quality-adjusted life year (QALY), which itself is calculated by multiplying the difference in preoperative and postoperative health-related quality of life by life expectancy. Health-related quality of life was determined through use of the Quality of Well-Being scale.
“Costs are facility charges per the facility cost-to-charges ratio plus surgeon fee,” the authors wrote. “Sensitivity analyses are performed to determine the effect of variations in costs or outcomes.”
With a mean follow-up of 2.1 years, the authors were able to determine a cost per QALY of $5,783 for arthroscopy and $10,326 for ACL reconstruction.
“Sensitivity analysis shows that our results are robust (relatively insensitive) to variations in costs or outcomes,” the authors wrote.
In this interesting article Lubowitz et al. provide insight, in the mathematical and technical basis, of calculating the cost-effectiveness for knee arthroscopy and ACL reconstruction.
Knee arthroscopy and ACL reconstruction are two very commonly performed surgical procedures in Orthopedics. Although both have proven themselves as clinically effective, a ratio of the cost to their effect respectively was yet to be analyzed. This study has done so thoroughly.
The conclusion of this study –that both procedures are very cost-effective- lets itself be easily explained by the fact that potentially highly incapacitating conditions are treated at a relatively low cost. Knee pain or instability for instance can be very disabling conditions and even lead to immobility, while the treatment is relatively low-complex and can be performed in an outpatient clinic.
The presented results are positive, but may be fairly optimistic. We must not be misled by the fact that the effectiveness of the treatment seems to outweigh the cost now; this may only be so in the short-term. At long-term follow up the results may be less successful. The cost may rise and the physical condition may decline. Further research is needed. We must await long-term results to be definitive.
— Paulo H. Araujo, MD
Research Fellow
University of Pittsburgh
Pittsburgh, PA