title: The Cost-Effectiveness of Measures to Prevent Recurrent Ankle Sprains: Results of a 3-Arm Randomized Controlled Trial.
abstract: BACKGROUND
  Ankle sprains are the most common sports-related injury, associated with a high rate of recurrence and societal costs. Recent studies have emphasized the effectiveness of both neuromuscular training and bracing for the secondary prevention of ankle sprains.
  
  
  OBJECTIVE
  To evaluate the cost-effectiveness of the separate and combined use of bracing and neuromuscular training for the prevention of the recurrence of ankle sprains.
  
  
  METHODS
  Economic and decision analysis; Level of evidence, 2.
  
  
  METHODS
  A total of 340 athletes (157 male and 183 female; aged 12-70 years) who had sustained a lateral ankle sprain up to 2 months before inclusion were randomized to a neuromuscular training group (n = 107), brace group (n = 113), and combined intervention group (n = 120). Randomization was stratified by medical treatment of the inclusion sprain. Participants in the neuromuscular training group underwent an 8-week home-based exercise program. Participants in the brace group received a semirigid ankle brace to be worn during all sports activities for a period of 12 months. Participants allocated to the combined group underwent both interventions, with the ankle brace to be worn during all sports activities for a period of 8 weeks. The recurrence of ankle sprains and associated costs were registered during the 1-year follow-up.
  
  
  RESULTS
  There were no differences between groups at baseline with regard to age, sex, sports participation, previous injury, or knowledge of preventive measures. The incremental cost-effectiveness ratio (ICER) of the brace group in comparison with the combined group was -€2828.30 (approximately--US$3865.00), based on a difference in the mean cost of -€76.16 (approximately--US$104.00) and a difference in the mean effects of 2.68%. The ICER of the neuromuscular training group in comparison with the combined group was €310.08 (approximately US$424.00), based on a difference in the mean cost of -€28.37 (approximately--US$39.00) and a difference in the mean effects of 9.15%.
  
  
  CONCLUSIONS
  Bracing was found to be the dominant secondary preventive intervention over both neuromuscular training and the combination of both measures.
authors.affiliation: Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Kasper W
authors.initials: KW
authors.lastname: Janssen
authors.affiliation: Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands Department of Human Movement Sciences, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands.
authors.forename: Marike R C
authors.initials: MR
authors.lastname: Hendriks
authors.affiliation: Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Willem
authors.initials: W
authors.lastname: van Mechelen
authors.affiliation: Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands e.verhagen@vumc.nl.
authors.forename: Evert
authors.initials: E
authors.lastname: Verhagen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000517:prevention & control*; D001265:Athletic Injuries / Q000517:prevention & control*; D001915:Braces; D002648:Child; D003362:Cost-Benefit Analysis; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055502:Secondary Prevention; D013180:Sprains and Strains / Q000191:economics / Q000517:prevention & control*; D055815:Young Adult
keywords: ankle brace; ankle sprain; cost-effectiveness; injury prevention; neuromuscular training; randomized controlled trial