No economic benefit of early knee reconstruction over optional delayed reconstruction for ACL tears: registry enriched randomised controlled trial data. Kiadaliri, A. A., Englund, M., Lohmander, L. S., Carlsson, K. S., & Frobell, R. B. 50(9):558--563.
doi  abstract   bibtex   
BACKGROUND: To analyse 5-year cost-effectiveness of early versus optional delayed acute anterior cruciate ligament (ACL) reconstruction. METHODS: 121 young, active adults with acute ACL injury to a previously uninjured knee were randomised to early ACL reconstruction (n=62, within 10 weeks of injury) or optional delayed ACL reconstruction (n=59; 30 with ACL reconstruction within 6-55 months); all patients received similar structured rehabilitation. Real life data on health care utilisation and sick leave were obtained from regional and national registers. Costs and quality-adjusted life years (QALYs) were discounted at 3%. Full-analysis set (based on study randomisation) and as-treated analysis (according to actual treatment over 5 years) principles were applied. RESULTS: Mean cost of early ACL reconstruction was euro4695 higher than optional delayed ACL reconstruction (p=0.19) and provided an additional 0.13 QALYs (p=0.11). Full-analysis set showed incremental net benefit of early versus optional delayed ACL reconstruction was not statistically significantly different from zero at any level. As-treated analysis showed that costs for rehabilitation alone were euro13 650 less than early ACL reconstruction (p\textless0.001). Results were robust to sensitivity analyses. CONCLUSIONS: In young active adults with acute ACL injury, a strategy of early ACL reconstruction did not provide extra economic value over a strategy of optional delayed ACL reconstruction over a 5-year period. Results from this and previous reports of the KANON-trial imply that early identification of individuals who would benefit from either early ACL reconstruction or rehabilitation alone might reduce resource consumption and decrease risk of unnecessary overtreatment. TRIAL REGISTRATION: ISRCTN84752559.
@article{kiadaliri_no_2016,
	title = {No economic benefit of early knee reconstruction over optional delayed reconstruction for {ACL} tears: registry enriched randomised controlled trial data.},
	volume = {50},
	rights = {Published by the {BMJ} Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/},
	issn = {1473-0480 0306-3674},
	doi = {10.1136/bjsports-2015-095308},
	abstract = {{BACKGROUND}: To analyse 5-year cost-effectiveness of early versus optional delayed acute anterior cruciate ligament ({ACL}) reconstruction. {METHODS}: 121 young, active adults with acute {ACL} injury to a previously uninjured knee were randomised to early {ACL} reconstruction (n=62, within 10 weeks of injury) or optional delayed {ACL} reconstruction (n=59; 30 with {ACL} reconstruction within 6-55 months); all patients received similar structured rehabilitation. Real life data on health care utilisation and sick leave were obtained from regional and national registers. Costs and quality-adjusted life years ({QALYs}) were discounted at 3\%. Full-analysis set (based on study randomisation) and as-treated analysis (according to actual treatment over 5 years) principles were applied. {RESULTS}: Mean cost of early {ACL} reconstruction was euro4695 higher than optional delayed {ACL} reconstruction (p=0.19) and provided an additional 0.13 {QALYs} (p=0.11). Full-analysis set showed incremental net benefit of early versus optional delayed {ACL} reconstruction was not statistically significantly different from zero at any level. As-treated analysis showed that costs for rehabilitation alone were euro13 650 less than early {ACL} reconstruction (p{\textless}0.001). Results were robust to sensitivity analyses. {CONCLUSIONS}: In young active adults with acute {ACL} injury,  a strategy of early {ACL} reconstruction did not provide extra economic value over  a strategy of optional delayed {ACL} reconstruction over a 5-year period. Results from this and previous reports of the {KANON}-trial imply that early identification of individuals who would benefit from either early {ACL} reconstruction or rehabilitation alone might reduce resource consumption and decrease risk of unnecessary overtreatment. {TRIAL} {REGISTRATION}: {ISRCTN}84752559.},
	pages = {558--563},
	number = {9},
	journaltitle = {British journal of sports medicine},
	shortjournal = {Br J Sports Med},
	author = {Kiadaliri, Aliasghar A. and Englund, Martin and Lohmander, L. Stefan and Carlsson, Katarina Steen and Frobell, Richard B.},
	date = {2016-05},
	pmid = {26935859},
	keywords = {Economics, Effectiveness, Knee {ACL}, Randomised controlled trial, Rehabilitation}
}
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