title: Review of anterior cruciate ligament reconstruction cost variance within a regional health care system.
abstract: BACKGROUND
  Examination of value in health care has become a national priority in the United States. Regional variation in health care costs is an area of focus among national policy experts. Procedural cost data can be used to provide physicians with information to evaluate costs and value.
  
  
  OBJECTIVE
  To perform a cost review for anterior cruciate ligament (ACL) surgery to document the degree of variation in costs for ACL reconstruction.
  
  
  METHODS
  Economic and decision analysis; Level of evidence, 4.
  
  
  METHODS
  A procedural cost review was performed for isolated ACL reconstructions within a 22-surgeon, 7-hospital system. Five consistent cost categories under the influence of the surgeon were identified and were analyzed for cost variation among surgeons: tibial fixation, femoral fixation, graft choice, sutures, and tools or disposable instruments.
  
  
  RESULTS
  For these 5 categories, the total costs to perform an ACL reconstruction (in 2013 US dollars) ranged from $392.80 to $4670.31, a difference of $4277.51 and a mean of $2039.09. Tibial fixation costs ranged from $95.00 to $760.00 (mean, $293.52). Femoral fixation ranged from $95.00 to $865.00 (mean, $367.14). The graft cost ranged from $1275.00 to $2545.75 (mean, $1976.43). Suture prices for each individual suture varied from $1.19 to $46.00 (mean, $18.26). Tools and disposable supplies ranged from $40.10 to $2136.00 (mean, $452.33).
  
  
  CONCLUSIONS
  There were substantial differences in ACL reconstruction costs in the implant and disposable instruments categories. As health systems and physicians collaborate to improve health care quality and value for patients, information on cost variation will be important. Rational variation in health care cost is appropriate, reflecting variation due to the unique requirements of procedures and patient-centered care. Irrational variations in procedural costs are those that do not add additional value.
authors.affiliation: University of Utah School of Medicine, Salt Lake City, Utah, USA noah.archibalds@gmail.com.
authors.forename: Noah
authors.initials: N
authors.lastname: Archibald-Seiffer
authors.affiliation: University of Utah School of Medicine, Salt Lake City, Utah, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Jacobs
authors.affiliation: St Luke's Health System, Boise, Idaho, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Saad
authors.affiliation: Intermountain Healthcare, St George, Utah, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Jevsevar
authors.affiliation: St Luke's Health System, Boise, Idaho, USA St Luke's Sports Medicine, Boise, Idaho, USA Department of Orthopedics, University of Utah School of Medicine, Salt Lake City, Utah, USA.
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Shea
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000191:economics* / Q000379:methods; D003365:Costs and Cost Analysis; D005269:Femur / Q000601:surgery; D017048:Health Care Costs; D006801:Humans; D016377:Organ Transplantation / Q000191:economics; D013525:Surgical Instruments / Q000191:economics; D013531:Surgicenters / Q000191:economics; D013537:Sutures / Q000191:economics; D013977:Tibia / Q000601:surgery; D014481:United States
keywords: ACL; economic and decision analysis; knee; ligaments