OBJECTIVES: Ambulatory knee arthroscopic surgery (AKAS) has been initiated in health care system as the out-patient basis. Several studies indicated that ambulatory surgery had greater clinical outcomes than the in-patient knee arthroscopic surgery (IKAS). However, no economic evaluation study comparing these two pathways from the societal perspective in Thailand. The objective of this study is to conduct a cost-utility analysis and budget impact analysis (BIA) of AKAS compared with IKAS in Thailand from a societal perspective.

METHODS: A cost-utility analysis was performed to evaluate AKAS and IKAS. The analysis was done using the societal perspective and two weeks time horizon. Health outcomes were measured in a unit of quality-adjusted life-year (QALY) and cost were obtained from an electronic database at a tertiary-care hospital. The incremental cost-effectiveness ratio (ICER) was applied to demonstrate the costs and QALYs. One-way sensitivity analysis was used to investigate the robustness of the model. BIA was performed considering a 5-year time horizon.

RESULTS: The total cost of IKAS was 2,234 US Dollars (USD), while the AKAS cost was 2,001 USD. The QALYs of IKAS and AKAS were 0.79 and 0.81 respectively, resulting in AKAS becoming a dominant strategy over IKAS. AKAS led to net savings of 4.5 million USD over 5 years. Medical supply costs are one of the most influential factors affecting the change in results.

CONCLUSIONS: AKAS is a cost-saving strategy compared to IKAS due to lower treatment costs and yields better health outcomes. This finding ensures that one day procedure is a feasible alternative to traditional inpatient surgery. It should be recommended and applied this service in various types of hospital nationwide.