PDF(Pubmed)
Abstract：
BACKGROUND: The ideal approach for treating anterior cruciate ligament (ACL) injury is still disputed. This study aimed to determine the more cost-effective strategy by comparing early ACL reconstruction (ACLR) surgery to conservative treatment (rehabilitation with optional delayed reconstruction) for ACL injury in a lower/middle-income country (LMIC), Indonesia.
METHODS: A decision tree model was constructed for cost-utility analysis of early ACLR versus conservative treatment. The transition probabilities between states were obtained from the literature review. Utilities were measured by the EQ-5D-3 L from a prospective cohort study in a local hospital. The costs were obtained from a previous study that elaborated on the burden and cost of ACLR in Indonesia. Effectiveness was expressed in quality-adjusted life years gained (QALYs). Principal outcome measure was the incremental cost-effectiveness ratios (ICER). Willingness-to-pay was set at US$12,876 - three times the Indonesian GDP per capita in 2021 - the currently accepted standard in Indonesia as suggested by the World Health Organization Choosing Interventions that are Cost-Effective criterion (WHO-CHOICE).
RESULTS: The early ACLR group showed an incremental gain of 0.05 QALYs over the conservative treatment group, with a higher overall cost to society of US$976. The ICER of ACLR surgery was US$19,524 per QALY, above the WTP threshold of US$12,876. The ICER was sensitive to cost of conservative treatment, cost of ACLR, and rate of cross-over to delayed ACLR numbers in the conservative treatment group. Using the WTP threshold of US$12,876, the probability of conservative treatment being preferred over early ACLR was 64%.
CONCLUSIONS: Based on the current model, early ACLR surgery does not seem more cost-effective compared to conservative treatment for ACL injury patients in Indonesia. Because the result was sensitive to the rate of cross-over probabilities from the conservative treatment alone to delayed ACLR, a future study with a long-term perspective is needed to further elucidate its impact.
METHODS: A decision tree model was constructed for cost-utility analysis of early ACLR versus conservative treatment. The transition probabilities between states were obtained from the literature review. Utilities were measured by the EQ-5D-3 L from a prospective cohort study in a local hospital. The costs were obtained from a previous study that elaborated on the burden and cost of ACLR in Indonesia. Effectiveness was expressed in quality-adjusted life years gained (QALYs). Principal outcome measure was the incremental cost-effectiveness ratios (ICER). Willingness-to-pay was set at US$12,876 - three times the Indonesian GDP per capita in 2021 - the currently accepted standard in Indonesia as suggested by the World Health Organization Choosing Interventions that are Cost-Effective criterion (WHO-CHOICE).
RESULTS: The early ACLR group showed an incremental gain of 0.05 QALYs over the conservative treatment group, with a higher overall cost to society of US$976. The ICER of ACLR surgery was US$19,524 per QALY, above the WTP threshold of US$12,876. The ICER was sensitive to cost of conservative treatment, cost of ACLR, and rate of cross-over to delayed ACLR numbers in the conservative treatment group. Using the WTP threshold of US$12,876, the probability of conservative treatment being preferred over early ACLR was 64%.
CONCLUSIONS: Based on the current model, early ACLR surgery does not seem more cost-effective compared to conservative treatment for ACL injury patients in Indonesia. Because the result was sensitive to the rate of cross-over probabilities from the conservative treatment alone to delayed ACLR, a future study with a long-term perspective is needed to further elucidate its impact.
摘要：
背景：治疗前交叉韧带（ACL）损伤的理想方法仍然存在争议。这项研究旨在通过比较早期ACL重建（ACLR）手术与保守治疗（康复与可选的延迟重建）在低/中等收入国家（LMIC）ACL损伤确定更具成本效益的策略。印度尼西亚。
方法：构建了一个决策树模型，用于早期ACLR与保守治疗的成本效用分析。状态之间的转移概率是从文献综述中获得的。在当地医院的一项前瞻性队列研究中，通过EQ-5D-3L测量了效用。费用是从先前的一项研究中获得的，该研究阐述了印度尼西亚ACLR的负担和费用。有效性以获得的质量调整生命年(QALYs)表示。主要结果衡量标准是增量成本效益比(ICER)。支付意愿定为12,876美元，是2021年印度尼西亚人均GDP的三倍，这是世界卫生组织（WHO-CHOICE）建议的印度尼西亚目前接受的标准。
结果：早期ACLR组比保守治疗组增加了0.05QALYs，对社会的总体成本较高，为976美元。ACLR手术的ICER为每QALY19,524美元，高于12,876美元的WTP门槛。ICER对保守治疗的费用很敏感，ACLR的成本，以及保守治疗组中延迟ACLR数的交叉率。使用12,876美元的WTP阈值，保守治疗优于早期ACLR的可能性为64％。
结论：基于当前模型，与印度尼西亚ACL损伤患者的保守治疗相比,早期ACLR手术似乎没有更高的成本效益.因为结果对从保守治疗到延迟ACLR的交叉概率敏感，未来需要一项具有长期视角的研究来进一步阐明其影响.
方法：构建了一个决策树模型，用于早期ACLR与保守治疗的成本效用分析。状态之间的转移概率是从文献综述中获得的。在当地医院的一项前瞻性队列研究中，通过EQ-5D-3L测量了效用。费用是从先前的一项研究中获得的，该研究阐述了印度尼西亚ACLR的负担和费用。有效性以获得的质量调整生命年(QALYs)表示。主要结果衡量标准是增量成本效益比(ICER)。支付意愿定为12,876美元，是2021年印度尼西亚人均GDP的三倍，这是世界卫生组织（WHO-CHOICE）建议的印度尼西亚目前接受的标准。
结果：早期ACLR组比保守治疗组增加了0.05QALYs，对社会的总体成本较高，为976美元。ACLR手术的ICER为每QALY19,524美元，高于12,876美元的WTP门槛。ICER对保守治疗的费用很敏感，ACLR的成本，以及保守治疗组中延迟ACLR数的交叉率。使用12,876美元的WTP阈值，保守治疗优于早期ACLR的可能性为64％。
结论：基于当前模型，与印度尼西亚ACL损伤患者的保守治疗相比,早期ACLR手术似乎没有更高的成本效益.因为结果对从保守治疗到延迟ACLR的交叉概率敏感，未来需要一项具有长期视角的研究来进一步阐明其影响.
