Cost-Utility Analysis of Early Reconstruction Surgery Versus Rehabilitation and Delayed Reconstruction for Anterior Cruciate Ligament Tears in Low and Middle-Income Country
Author(s)
Deviandri R1, Icanervilia AV2, Purba AKR3, van Der Veen H4, Lubis A5, van Den Akker-Scheek I4, Postma MJ6
1UMCG - UNRI, Groningen- Pekanbaru, Netherlands, 2University of Groningen, University Medical Center Groningen, Groningen, GR, Netherlands, 3Academic Hospital of Universitas Airlangga, Groningen, GR, Netherlands, 4umcg, groningen, Netherlands, 5RSCM, Jakarta, Indonesia, 6UMCG, Zeist, UT, Netherlands
OBJECTIVES: Considerable debate remains regarding the preferred strategy for managing individuals following an ACL tears. This study aimed to determine the more cost-effective strategy between early ACL reconstruction surgery (early ACLR) versus rehabilitation plus optional delayed reconstruction (rehabilitation) for ACL tears in LMIC, focusing on Indonesia
METHODS: A decision tree model was constructed for cost-utility analysis of early ACLR versus rehabilitation. The state of transition probabilities was obtained from the literature review. Utilities were measured by the EQ-5D-3L from the prospective cohort of Comparison Effectiveness Analysis Between ACL Reconstruction and Rehabilitation in Peripheral and Main Capital in Indonesia (Cetjap-Asin study- ClinicalTrials.gov ID: NCT04748328-). The cost was obtained from the previous study that elaborated on the burden and cost of ACLR in Indonesia, which was estimated in 2020 US dollars. Effectiveness was expressed in quality-adjusted life years gained (QALYs). Principal outcome measures were calculated as the incremental cost-effectiveness ratio (ICER). Willingness-to-pay was set at US$12,876 which is three times of the Indonesian GDP per capita in 2021
RESULTS: In the base case, the early ACLR group resulted in an incremental gain of 0.05 QALYs over the rehabilitation group, with a higher overall cost to society of $986. The ICER of early ACLR was $19,719 per QALY, above the WTP threshold of $12,876. The ICER was sensitive to the cost of ACLR, the cost of rehabilitation, the rate of cross-over probability of delayed ACLR numbers in the rehabilitation group, and the quality of life after treatment of both strategies. When the rate of cross-over probability from rehabilitation alone to be delayed ACLR could be more than 50%, it would change the less cost-effective rehabilitation strategy than the early ACLR strategy
CONCLUSIONS: Early ACLR surgery was a less cost-effective strategy than rehabilitation for chronic ACL tears patients in LMIC countries, particularly Indonesia
Conference/Value in Health Info
Value in Health, Volume 26, Issue 6, S2 (June 2023)
Code
EE365
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal), Surgery