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Cost-effectiveness analysis of surgical versus non-surgical management of acute Achilles tendon ruptures.

Artikel i vetenskaplig tidskrift
Författare Olof Westin
Mikael Svensson
Katarina Nilsson-Helander
Kristian Samuelsson
Karin Grävare Silbernagel
Nicklas Olsson
Jon Karlsson
Elisabeth Hansson-Olofsson
Publicerad i Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
Volym 26
Nummer/häfte 10
Sidor 3074–3082
ISSN 1433-7347
Publiceringsår 2018
Publicerad vid Institutionen för kliniska vetenskaper, Avdelningen för ortopedi
Institutionen för medicin, avdelningen för samhällsmedicin och folkhälsa, enheten för hälsometri
Sidor 3074–3082
Språk en
Länkar dx.doi.org/10.1007/s00167-018-4953-...
www.ncbi.nlm.nih.gov/entrez/query.f...
Ämneskategorier Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi

Sammanfattning

An Achilles tendon rupture is a common injury that typically affects people in the middle of their working lives. The injury has a negative impact in terms of both morbidity for the individual and the risk of substantial sick leave. The aim of this study was to investigate the cost-effectiveness of surgical compared with non-surgical management in patients with an acute Achilles tendon rupture.One hundred patients (86 men, 14 women; mean age, 40 years) with an acute Achilles tendon rupture were randomised (1:1) to either surgical treatment or non-surgical treatment, both with an accelerated rehabilitation protocol (surgical n = 49, non-surgical n = 51). One of the surgical patients was excluded due to a partial re-rupture and five surgical patients were lost to the 1-year economic follow-up. One patient was excluded due to incorrect inclusion and one was lost to the 1-year follow-up in the non-surgical group. The cost was divided into direct and indirect costs. The direct cost is the actual cost of health care, whereas the indirect cost is the production loss related to the impact of the patient's injury in terms of lost ability to work. The health benefits were assessed using quality-adjusted life years (QALYs). Sampling uncertainty was assessed by means of non-parametric boot-strapping.Pre-injury, the groups were comparable in terms of demographic data and health-related quality of life (HRQoL). The mean cost of surgical management was €7332 compared with €6008 for non-surgical management (p = 0.024). The mean number of QALYs during the 1-year time period was 0.89 and 0.86 in the surgical and non-surgical groups respectively. The (incremental) cost-effectiveness ratio was €45,855. Based on bootstrapping, the cost-effectiveness acceptability curve shows that the surgical treatment is 57% likely to be cost-effective at a threshold value of €50,000 per QALY.Surgical treatment was more expensive compared with non-surgical management. The cost-effectiveness results give a weak support (57% likelihood) for the surgical treatment to be cost-effective at a willingness to pay per QALY threshold of €50,000. This is support for surgical treatment; however, additionally cost-effectiveness studies alongside RCTs are important to clarify which treatment option is preferred from a cost-effectiveness perspective.I.

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