Computer-assisted navigation in ACL reconstruction is attractive but not yet cost efficient.
OBJECTIVE
Conventional reconstruction of the anterior cruciate ligament (ACL) has a high success rate. Computer-assisted navigation systems (CANSs) have been developed to further improve the accuracy of tunnel positioning. What is the economic impact from the hospital perspective?


METHODS
Patients having a first ACL reconstruction procedure were included in a prospective multicentre open controlled study comparing two groups: CANS versus conventional surgery. The primary clinical efficacy criterion was the objective International Knee Documentation Committee score at 1-2-year follow-up. Costs were collected retrospectively nationwide.


RESULTS
No significant differences were found for the clinical effectiveness between conventional surgery (100 patients) and CANS (114 patients) at follow-up: ORadjusted 1.01 [0.36-2.84] (n.s). Junior surgeons achieved a significant mean decrease in operating time during the study period: 30 % in the CANS group compared with 10 % in the control group (p < 0.01). The average cost of surgery was 704<euro> for the control group and 1,158<euro> for the CANS group (p < 0.01). The cost of the operating room accounts for >70 % of the total cost. The surgeon's status and the technical CANS learning effect influenced this cost. The cost differential between the two groups decreased with 'CANS' expertise: 238<euro> and 271<euro> in 'expert' centres versus 427<euro> to 731<euro> in other centres.


CONCLUSIONS
While our study demonstrates the feasibility and the potential interest of CANS for training in ACL reconstruction, from a hospital perspective it is not cost efficient at present.


METHODS
Economic and decision analysis-developing an economic or decision model, Level II.
Cellule d'évaluation médico-économique des innovations, Pavillon Taillefer, CHU de Grenoble, 38043, Grenoble, France, jmargier@chu-grenoble.fr.
Jennifer
J
Margier
Sandra David
SD
Tchouda
Jean-Jacques
JJ
Banihachemi
Jean-Luc
JL
Bosson
Stéphane
S
Plaweski
D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005260:Female; D005602:France; D006784:Hospitals, Teaching / Q000191:economics; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000191:economics; D016896:Treatment Outcome