Autograft versus allograft: an economic cost comparison of anterior cruciate ligament reconstruction.

PURPOSE: The purpose of this study was to compare the costs associated with anterior cruciate ligament (ACL) reconstruction with either bone-patellar tendon-bone (BPTB) autograft or BPTB allograft. METHODS: Surgical costs are reported, including supply costs, based on invoice costs per item used per procedure, and personnel costs calculated as cost per minute. All operations were performed at an ambulatory surgery center between March 2005 and March 2006. A total of 160 patients underwent primary ACL reconstruction with either BPTB autograft (n = 106) or BPTB allograft (n = 54). Procedure cost data were retrieved from a financial management database and divided into various categories for comparison of the 2 groups. Payment data were provided by the surgery center's billing office. RESULTS: The total mean cost per case was $4,147 ± $943 in the allograft group compared with $3,154 ± $704 in the autograft group; this was statistically significant (P < .001). The mean operating room time was 12 minutes greater in autograft cases (P = .006). Supply costs comprised a mean of 58.7% of total expenses in the autograft group and 72.2% in the allograft group. CONCLUSIONS: Allograft reconstruction of the ACL was significantly more expensive than autograft reconstruction. LEVEL OF EVIDENCE: Level II, economic analysis.

Cost analysis of converting from single-bundle to double-bundle anterior cruciate ligament reconstruction.

BACKGROUND: Recent studies comparing double-bundle anterior cruciate ligament reconstruction to single-bundle anterior cruciate ligament reconstruction have reported some biomechanical advantages but little or no short-term clinical benefit from the double-bundle technique. In the current healthcare environment, the potential economic implications of widespread conversion to a double-bundle anterior cruciate ligament reconstruction are an important consideration. PURPOSE: To determine the economic implications of widespread use of the double-bundle technique for anterior cruciate ligament reconstruction. STUDY DESIGN: Economic analysis; Level of evidence, 2. METHODS: A cost model to assess the effect of double-bundle anterior cruciate ligament reconstruction was constructed using standard accounting methodology. The model was based on actual 2008 cost figures (in US dollars) for ligamentous allografts, fixation implants, and operating room time. Revision rate (4%) and time to revision surgery (mean, 4 years) for single-bundle anterior cruciate ligament reconstruction was based on the available literature. Assumptions about the prevalence of double-bundle versus single-bundle anterior cruciate ligament reconstruction, the number of grafts used, and the revision rate for double-bundle reconstruction were varied to assess their effect on cost. RESULTS: The potential additional cost for widespread conversion to the double-bundle technique for anterior cruciate ligament reconstruction ranges from $36 million to $792 million per year in the United States alone. To offset this increased cost, the double-bundle technique would have to reduce the revision rate at a minimum from 4% to 1.5% and potentially from 24.1% to 0%. CONCLUSION: Double-bundle anterior cruciate ligament reconstruction has the potential of adding considerable cost to the health-care system. CLINICAL RELEVANCE: While further research is warranted to determine if there are other benefits from this technique, widespread adoption of a double-bundle anterior cruciate ligament reconstruction does not appear to be cost-effective at this time.

[Cost analysis and economic impact of anterior cruciate ligament reconstruction]. / Análisis de costo e impacto económico de la reconstrucción de ligamento cruzado anterior (LCA).

INTRODUCTION: Health economics studies play an important role in all healthcare systems. The purpose of the latter is to offer effective and low-cost treatments. OBJECTIVE: Analyze the costs and the economic impact of the comprehensive ACL treatment. MATERIAL AND METHODS: An average cost study was done of primary ACL reconstruction. We studied 104 patients during 2005, 79 males and 25 females, with mean age 31.5 years. The assessment of the preoperative, operative and postoperative costs was related to each patient's socioeconomic stratum (SES). RESULTS: The hamstrings were the most frequently used graft (71%) versus the bone-patellar tendon-bone graft (BTB) (29%). Socioeconomic strata 2 and 3 were predominant. The following were the most frequent hamstrings implants used: Rigidfix/Intrafix and Endobutton/Xtralok, while the most frequent BTB grafts used were the metallic interference screws. No difference was found between the types of grafts and the SES in the preoperative and postoperative costs, including imaging studies, hospital say and rehabilitation. However, differences were found among the different groups in the cost of surgery, resulting from the type of implant used. The mean cost for SES 1 and 2 was $6475.20, for SES 3 and 4, $8057.51, and for SES 5 and 6, $16,242.5. The vulnerable population (SES 1) needs 7.34-fold its monthly income to pay for the comprehensive treatment, while the middle stratum (SES 3) needs 3.27-fold its monthly income. CONCLUSIONS: The comprehensive cost of treatment is proportionally higher than the patients' income. It is important to point out that the systems using state-of-the-art technology, which in another setting would be inaccessible, have significant advantages when compared with the less expensive systems. Thus the economically vulnerable SES benefit from the subsidy granted by the National Institutes of Health.

ACL reconstruction: patellar tendon versus hamstring grafts--economical aspects.

The aim of the present investigation was to compare the costs for the use of patellar tendon versus hamstring tendons as grafts for anterior cruciate ligament (ACL) reconstruction including the different fixation methods. The background is that during recent years there has been a dramatic shift from patellar tendon to hamstring tendons in ACL reconstructions in Sweden. All our patients with ACL reconstructions performed during 1 year (2004) were included. Knee joints numbering 440 in 439 patients were primary ACL reconstructions. A hamstring graft was used in 345 knee joints (78.4%) and a patellar tendon graft in 95 (21.6%) of the patients (Table 2). On average 34 (SD 12.9; range 14-63) ACL reconstructions per surgeon were performed by a total of 14 surgeons. The average cost for patellar tendon procedure was 197 euros compared to 436 euros for the hamstring procedure. Mean time for surgery in primary reconstructions was 11.5 min shorter (P<0.001) for patellar tendon reconstructions (71.3+/-31 min) compared to hamstring reconstructions (83.2+/-27 min). This means a difference in cost of 90 euros. The total additional cost (fixation and surgery time) for the hamstring method compared to the patellar tendon method was on an average 329 euros. From a strict economic point of view we therefore recommend or at least consider the use of the patellar tendon as a graft in ACL reconstructions.