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Erschienen in:
01.04.2015 | Knee
Computer-assisted navigation in ACL reconstruction is attractive but not yet cost efficient
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 4/2015
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Purpose
Conventional reconstruction of the anterior cruciate ligament (ACL) has a high success rate. Computer-assisted navigation systems (CANSs) have been developed to further improve the accuracy of tunnel positioning. What is the economic impact from the hospital perspective?
Methods
Patients having a first ACL reconstruction procedure were included in a prospective multicentre open controlled study comparing two groups: CANS versus conventional surgery. The primary clinical efficacy criterion was the objective International Knee Documentation Committee score at 1–2-year follow-up. Costs were collected retrospectively nationwide.
Results
No significant differences were found for the clinical effectiveness between conventional surgery (100 patients) and CANS (114 patients) at follow-up: ORadjusted 1.01 [0.36–2.84] (n.s). Junior surgeons achieved a significant mean decrease in operating time during the study period: 30 % in the CANS group compared with 10 % in the control group (p < 0.01). The average cost of surgery was 704€ for the control group and 1,158€ for the CANS group (p < 0.01). The cost of the operating room accounts for >70 % of the total cost. The surgeon’s status and the technical CANS learning effect influenced this cost. The cost differential between the two groups decreased with ‘CANS’ expertise: 238€ and 271€ in ‘expert’ centres versus 427€ to 731€ in other centres.
Conclusion
While our study demonstrates the feasibility and the potential interest of CANS for training in ACL reconstruction, from a hospital perspective it is not cost efficient at present.
Level of evidence
Economic and decision analysis—developing an economic or decision model, Level II.