Cost effectiveness of anterior cruciate ligament reconstruction in young adults

The cost effectiveness of ligament reconstruction for acute anterior crucia te ligament tears in young adults was compared with the cost effectiveness of nonoperative management. A decision tree was constructed to predict the expected functional outcomes for operative and nonoperative treatment, Outc ome probabilities were derived from the surgical and natural history litera ture. Cost data were based on averaged figures from the senior author's ins titution, Utility values were determined from a questionnaire administered to 285 local university students. Cost effectiveness was calculated in term s of dollars spent per additional quality adjusted life year provided by th e surgical reconstruction for the initial 7 years after an injury, The oper ative strategy provided 5.10 quality adjusted life years versus 3.49 years for nonoperative treatment, yielding a marginal effectiveness of 1.61 quali ty adjusted life years. The estimated total costs of the operative and nono perative strategies were $11,768 and $2333, respectively, for a marginal co st of $9435, The resulting marginal cost effectiveness ratio was $5857 per quality adjusted life year. These data suggest that, when based on function al outcomes, anterior cruciate ligament reconstruction is a cost effective method of treatment For acute tears in young adults. The cost effectiveness ratio predicted compares favorably with those of other health care interve ntions that aim to improve quality of life.