Background:

Safe return to play (RTP) after anterior cruciate ligament (ACL) reconstruction is critical to patient satisfaction. Enhanced rehabilitation after ACL reconstruction with appropriate objective criteria for RTP may reduce the risk of subsequent injury. The cost-effectiveness of an enhanced RTP (eRTP) strategy relative to standard post-ACL reconstruction rehabilitation has not been investigated.

Purpose:

To determine if an eRTP strategy after ACL reconstruction is cost-effective compared with standard rehabilitation.

Study Design:

Economic and decision analysis.

Methods:

A decision-analysis model was utilized to compare standard rehabilitation with an eRTP strategy, which includes additional neuromuscular retraining, advanced testing, and follow-up physician visits. Cost-effectiveness was evaluated from a payer perspective. Costs of surgical procedures and rehabilitation protocols, risks of graft rupture and contralateral ACL injury, risk reductions as a result of the eRTP strategy, and relevant health utilities were derived from the literature. An incremental cost-effectiveness ratio of <$100,000/quality-adjusted life-year was used to determine cost-effectiveness. Sensitivity analyses were performed on pertinent model parameters to assess their effect on base case conclusions. In the base case analysis, the eRTP strategy cost was conservatively estimated to be $969 more than the standard rehabilitation protocol. Completion of the eRTP strategy was considered to confer a 25% risk reduction for graft rupture in comparison with standard rehabilitation.

Results:

The eRTP strategy was more cost-effective than standard rehabilitation alone. Based on 1-way threshold analyses, the eRTP strategy was cost-effective as long as its additional cost over standard rehabilitation was <$2092 or the eRTP strategy decreased the incidence of contralateral ACL rupture by >13.8%.

Conclusion:

The eRTP strategy in this study adds additional neuromuscular retraining and additional physician follow-up—as well as advanced testing goals upon which RTP is contingent—to traditional physical therapy. Our data suggest that these additions are cost-effective, even assuming only modest associated decreases in ACL graft failure. This study also determined that the only variable that had the potential to change the cost-effectiveness conclusion based on predetermined ranges was the additional cost of rehabilitation based on 1-way sensitivity analysis.

Clinical Relevance:

This study provides evidence of cost-effectiveness for payers, supporting the use of enhanced RTP programs. The sensitivity analyses herein may be used to determine if any given RTP program going forward is cost-effective, regardless of the exact components of the program.

中文翻译：

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更安全，更便宜：年轻运动员的前十字韧带重建后，基于里程碑的增强的重返比赛计划与标准的基于时间的重返比赛标准相比具有成本效益。

背景：

重建前交叉韧带（ACL）后的安全复位（RTP）对于患者满意度至关重要。重建ACL后采用适当的RTP客观标准加强康复治疗，可以减少随后受伤的风险。相对于标准ACL后重建康复，尚未研究增强的RTP（eRTP）策略的成本效益。

目的：

为了确定ACL重建后的eRTP策略与标准康复相比是否具有成本效益。

学习规划：

经济和决策分析。

方法：

利用决策分析模型将标准康复治疗与eRTP策略进行比较，其中包括额外的神经肌肉再培训，高级测试和随访医师就诊。从付款人角度评估了成本效益。从文献中得出了外科手术和康复方案的成本，移植物破裂和对侧ACL损伤的风险，eRTP策略导致的风险降低以及相关的卫生用途。成本效益比通过每质量调整生命周期<100,000美元/质量调整生命年递增来确定。对相关模型参数进行了敏感性分析，以评估它们对基本案例结论的影响。在基本案例分析中，据保守估计，eRTP策略的费用比标准康复方案高969美元。与标准康复相比，eRTP策略的完成被认为可以降低25％的移植物破裂风险。

结果：

eRTP策略比仅标准康复更具成本效益。根据单向阈值分析，eRTP策略是符合成本效益的，只要它比标准康复治疗的额外费用＜2092美元或eRTP策略将对侧ACL破裂的发生率降低13.8％以上。

结论：

这项研究中的eRTP策略为传统的物理疗法增加了额外的神经肌肉再培训和额外的医生随访，以及视RTP而定的高级测试目标。我们的数据表明，即使仅假设ACL移植失败的相关减少幅度适中，这些补充剂仍具有成本效益。这项研究还确定，唯一可能改变基于预定范围的成本效益结论的变量是基于单向敏感性分析的康复额外费用。

临床相关性：

这项研究为付款人提供了成本效益的证据，支持使用增强的RTP计划。无论程序的确切组件如何，本文中的灵敏度分析均可用于确定未来进行的任何给定RTP程序是否具有成本效益。