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

Abstract

PurposeAn 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.MethodsOne 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.ResultsPre-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.ConclusionsSurgical 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.Level of evidenceI.

Morphological and functional outcomes of operatively treated Achilles tendon ruptures

“…Research [14,15,28,43] has shown the aforementioned factors to be important factors in influencing patient outcomes and the reporting of these aspects should be encouraged within the scientific literature. It must be acknowledged that there are still multiple factors capable of impacting on patient outcomes which were not controlled in the current study including the degree of tendon separation prior to surgery [48], the magnitude of tendon elongation post-surgery [32] Tables Table 1. Descriptive statistics (mean [standard deviation]) for the 10 items in the ATRS along with the total score. r values depict the relationship between each ATRS item and months since surgery.…”

Efficacy of early controlled motion of the ankle compared with immobilisation in non-operative treatment of patients with an acute Achilles tendon rupture: an assessor-blinded, randomised controlled trial

“…Acute Achilles tendon rupture poses a substantial socioeconomic burden,1 affecting work-active adults and with an incidence of 20–32 per 100 000 per year 2 3. Results of treatment are unsatisfactory, as one out of three patients end up with poor outcome after treatment4 5 and the deficits persist for many years 6…”

The economic cost and patient-reported outcomes of chronic Achilles tendon ruptures

“…Prior to this study, there have only been a few health-economic studies that have evaluated the economic cost of Achilles tendon ruptures. Truntzer et al [ 25 ] and Westin et al [ 27 ] have evaluated whether operative or nonoperative treatment is economically favorable when it comes to Achilles tendon ruptures. Moreover, Carmont et al [ 4 ] compared the economic impact of the open and percutaneous repair of Achilles tendon ruptures.…”

“…The health-care costs used in this study are presented in Table 1 . The data was later compared with statistics from the economic study performed by Westin et al [ 27 ]. In that study, the economic cost of the operative and nonoperative treatment of acute Achilles tendon ruptures at the same Sahlgrenska University Hospital between 2009 and 2010 were analyzed.…”