Surgical reconstruction is a cost-efficient treatment option for isolated PCL injuries

Knee Surg Sports Traumatol Arthrosc. 2018 Apr;26(4):1053-1058. doi: 10.1007/s00167-017-4632-5. Epub 2017 Jul 14.

Abstract

Purpose and hypothesis: The main purpose of the study is to put focus on the costs related to treating posterior cruciate ligament (PCL) injuries and the possible implications of chosen treatment strategy to the respective institutions and society.

Methods: Costs of treating PCL injuries nonoperatively and for both single-bundle (SB) and double-bundle (DB) reconstruction were estimated. These costs were translated into equivalent quality-adjusted life years (QALY) given a threshold value of Euro (€) 70,000 per QALY. Expected gain in knee osteoarthritis outcome score (KOOS) quality of life (QoL) following surgery based on KOOS data from 112 patients was used as a basis for calculating the cost efficiency ratio.

Results: The average calculated cost of nonoperative treatment was €3382. Incremental cost for SB PCLR was €8585 (154%) and another increment of €5220 (61%) for DB PCLR using numbers from a European hospital. This is equivalent to increments of 0.074 (SB) and another 0.075 (DB) QALYs given the €70,000 threshold. For DB to be as cost efficient as SB reconstruction, the incremental gain in KOOS QoL has to be at the same level as for SB reconstruction compared to nonoperative treatment.

Conclusion: Though surgical reconstruction adds a substantial cost to nonoperative treatment alone, it can be considered cost-effective. Double-bundle reconstruction is less cost efficient than SB reconstruction, but should probably still be considered the treatment of choice for certain patient categories. Randomized controlled trials looking at outcome following nonoperative, SB and DB PCL reconstruction are needed. The clinical relevance of this is that surgical reconstruction of PCL injuries is a cost-efficient treatment alternative in patients with an isolated PCL injury. This finding should be taken into consideration when deciding on how to treat these injuries.

Level of evidence: III.

Keywords: Cost of treatment of PCL injury; Health economics; Knee; Knee ligament; Knee registries; Posterior cruciate ligament.

MeSH terms

  • Conservative Treatment / economics
  • Cost-Benefit Analysis
  • Europe
  • Humans
  • Knee Injuries / economics
  • Knee Injuries / therapy*
  • Orthopedic Procedures / economics
  • Posterior Cruciate Ligament / injuries*
  • Posterior Cruciate Ligament / surgery*
  • Quality of Life
  • Quality-Adjusted Life Years