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- Title
Computer-assisted navigation in ACL reconstruction is attractive but not yet cost efficient.
- Authors
Margier, Jennifer; Tchouda, Sandra; Banihachemi, Jean-Jacques; Bosson, Jean-Luc; Plaweski, Stéphane
- Abstract
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: OR 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.
- Subjects
ANTERIOR cruciate ligament surgery; COMPUTER-assisted surgery; MEDICAL care costs; SURGICAL robots; KNEE surgery
- Publication
Knee Surgery, Sports Traumatology, Arthroscopy, 2015, Vol 23, Issue 4, p1026
- ISSN
0942-2056
- Publication type
Article
- DOI
10.1007/s00167-013-2831-2