Cost-Effectiveness Analysis of the Most Common Orthopaedic Surgery Procedures: Knee Arthroscopy and Knee Anterior Cruciate Ligament Reconstruction

PurposeThe purpose of this study was to determine the cost-effectiveness of knee arthroscopy and anterior cruciate ligament (ACL) reconstruction.MethodsRetrospective analysis of prospectively collected data from a single-surgeon, institutional review board–approved outcomes registry included 2 cohorts: surgically treated knee arthroscopy and ACL reconstruction patients. Our outcome measure is cost-effectiveness (cost of a quality-adjusted life-year [QALY]). The QALY is calculated by multiplying difference in health-related quality of life, before and after treatment, by life expectancy. Health-related quality of life is measured by use of the Quality of Well-Being scale, which has been validated for cost-effectiveness analysis. Costs are facility charges per the facility cost-to-charges ratio plus surgeon fee. Sensitivity analyses are performed to determine the effect of variations in costs or outcomes.ResultsThere were 93 knee arthroscopy and 35 ACL reconstruction patients included at a mean follow-up of 2.1 years. Cost per QALY was $5,783 for arthroscopy and $10,326 for ACL reconstruction (2009 US dollars). Sensitivity analysis shows that our results are robust (relatively insensitive) to variations in costs or outcomes.ConclusionsKnee arthroscopy and knee ACL reconstruction are very cost-effective.Level of EvidenceLevel I, economic analysis (sensible costs with multiway sensitivity analyses).