title: Cost-effectiveness of anterior cruciate ligament reconstruction: a preliminary comparison of single-bundle and double-bundle techniques.
abstract: BACKGROUND
  There has been growing interest in anatomical reconstruction of the anterior cruciate ligament (ACL), including the use of double-bundle (DB) reconstruction techniques.
  
  
  OBJECTIVE
  The DB technique will not be cost-effective when compared with single-bundle (SB) reconstruction.
  
  
  METHODS
  Economic and decision analysis; Level of evidence, 1.
  
  
  METHODS
  A decision-analysis model with input values derived from the literature was used to estimate the cost-effectiveness of DB ACL reconstruction compared with SB ACL reconstruction. Effectiveness was based on the revision rate and the postoperative International Knee Documentation Committee (IKDC) score.
  
  
  RESULTS
  Sixty-four percent of DB knees result in an IKDC score of A, compared with 54% of SB knees. The incremental cost-effectiveness ratio of a DB reconstruction compared with an SB reconstruction was $6416 per quality adjusted life year in the baseline scenario and $64 371 per quality adjusted life year in the alternate scenario. The model is very sensitive to the proportions of IKDC A outcomes. The model is also sensitive to the utility values assigned to IKDC A and B outcomes and is less sensitive to the marginal cost of a DB reconstruction.
  
  
  CONCLUSIONS
  This preliminary analysis based on published clinical results to date shows DB ACL reconstruction may be cost-effective, despite increased upfront cost. More research is needed to confirm whether there is any difference in the distribution of IKDC outcomes between the 2 techniques. Perhaps more importantly, the lack of any other demonstrated clinical benefit from the DB technique questions the clinical relevance of this difference in IKDC scores.
  
  
  CONCLUSIONS
  Revision data and longer term outcomes after DB reconstruction and more reliable clinical utility data are needed to definitively compare the cost-effectiveness of DB and SB ACL reconstruction. Studies of ACL reconstruction and other sports medicine procedures should report the distribution of outcomes data to facilitate future analyses of clinical effectiveness.
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA.
authors.forename: E Scott
authors.initials: ES
authors.lastname: Paxton
authors.forename: Steven M
authors.initials: SM
authors.lastname: Kymes
authors.forename: Robert H
authors.initials: RH
authors.lastname: Brophy
mesh_terms: D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001265:Athletic Injuries / Q000191:economics* / Q000601:surgery; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D017048:Health Care Costs; D006801:Humans; D007719:Knee Joint / Q000473:pathology / Q000601:surgery*; D008923:Missouri; D015999:Multivariate Analysis; D019637:Orthopedic Procedures / Q000191:economics / Q000379:methods; D019057:Quality-Adjusted Life Years; D019651:Plastic Surgery Procedures / Q000191:economics* / Q000379:methods*; D016896:Treatment Outcome