Fabricant reports he is on the editorial or governing board and is a board or committee member for Pediatric Orthopaedic Society of North America, Pediatric Research in Sports Medicine Society and Research in OsteoChondritis of the Knee (ROCK). Please see the full study for all other authors’ relevant financial disclosures.
A comprehensive return-to-play program is cost-effective and reduces retear risk in young patients after ACL reconstructive surgery, according to a pediatric sports medicine specialist.
“Because they are young and they are very highly active, [children] tend to have less mature movement patterns and are also at the highest risk of retearing the graft and reinjuring the knee,” Peter D. Fabricant, MD, MPH, an orthopedic surgeon at Hospital for Special Surgery, told Healio Orthopedics.
“In these – kind of – enhanced return-to-play [RTP] programs, there are typically additional physical therapy visits that are associated with it,” Fabricant said. “There is additional testing in the form of motion analysis, strength testing, objective ligament testing – things that are not typically part of your standard physical therapy program.”
“We were trying to determine, what is the cost threshold or effectiveness threshold that would make it cost-effective from a payer standpoint,” he added.
According to their study, Fabricant and colleagues created a decision-analysis model to compare the standard ACL rehabilitation with a return-to-play RTP program, weighing the clinical and financial benefits.
They found that, while the cost of an RTP program was approximately $1,721 more than the standard rehabilitation protocol, the risk of ACL graft rupture after completing the RTP program was reduced by 25%.
After threshold analysis, Fabricant and colleagues determined that an RTP program is cost-effective, as long the additional cost of the RTP program was less than $2,092 or the risk of ACL graft rupture was reduced by more than 7.7%.
“In the end it’s cost saving for these insurance companies. So, they have to pay a little upfront, but they are covering less reoperation. So, they are actually saving money,” Fabricant said.
While from a clinical perspective, Fabricant is welcoming to idea of treating the average adult with an RTP program, he does not believe it would have the same financial value that it has in children.
“The cost-effectiveness model may not work as well for adults, because the absolute risk reduction is less than it would be in kids - just because their baseline risk of retearing is lower,” he said.
“I think as far as implications for future research. This can be an enduring tool to judge the cost-effectiveness of any given program - even a program generated in the future,” Fabricant said. “We are starting to present this data to insurance companies and saying, ‘Look, this is a valuable thing that you should not only pay for your clients, but you should enthusiastically cover,’ because even though there is an upfront cost associated with it, that cost is recovered,” he added.