Cost of Outpatient Arthroscopic Anterior Cruciate Ligament Reconstruction Among Commercially Insured Patients in the United States, 2005-2013

Mackenzie M. Herzog, Stephen W. Marshall, Jennifer L. Lund, Virginia Pate, Jeffrey T. Spang

Research output: Research - peer-reviewArticle

Abstract

Background: Despite the significance of anterior cruciate ligament (ACL) injuries, these conditions have been under-researched from a population-level perspective. It is important to determine the economic effect of these injuries in order to document the public health burden in the United States. Purpose: To describe the cost of outpatient arthroscopic ACL reconstruction and health care utilization among commercially insured beneficiaries in the United States. Study Design: Economic and decision analysis; Level of evidence, 3. Methods: The study used the Truven Health Analytics MarketScan Commercial Claims and Encounters database, an administrative claims database that contains a large sample (approximately 148 million) of privately insured individuals aged <65 years and enrolled in employer-sponsored plans. All claims with Current Procedural Terminology (CPT) code 29888 (arthroscopically aided ACL reconstruction or augmentation) from 2005 to 2013 were included. “Immediate procedure” cost was computed assuming a 3-day window of care centered on date of surgery. “Total health care utilization” cost was computed using a 9-month window of care (3 months preoperative and 6 months postoperative). Results: There were 229,446 outpatient arthroscopic ACL reconstructions performed over the 9-year study period. Median immediate procedure cost was $9399.49. Median total health care utilization cost was $13,403.38. Patients who underwent concomitant collateral ligament (medial [MCL], lateral [LCL]) repair or reconstruction had the highest costs for both immediate procedure ($12,473.24) and health care utilization ($17,006.34). For patients who had more than 1 reconstruction captured in the database, total health care utilization costs were higher for the second procedure than the first procedure ($16,238.43 vs $15,000.36), despite the fact that immediate procedure costs were lower for second procedures ($8685.73 vs $9445.26). Conclusion: These results provide a foundation for understanding the public health burden of ACL injuries in the United States. Our findings suggest that further research on the prevention and treatment of ACL injuries is necessary to reduce this burden.

LanguageEnglish (US)
JournalOrthopaedic Journal of Sports Medicine
Volume5
Issue number1
DOIs
StatePublished - Jan 27 2017

Fingerprint

Anterior Cruciate Ligament Reconstruction
Outpatients
Costs and Cost Analysis
Patient Acceptance of Health Care
Health Care Costs
Databases
Anterior Cruciate Ligament Injuries
Public Health
Economics
Current Procedural Terminology
Collateral Ligaments
Decision Support Techniques
Health
Wounds and Injuries
Research
Population
Therapeutics

Keywords

  • ACL reconstruction
  • anterior cruciate ligament
  • claims data
  • cost

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Cost of Outpatient Arthroscopic Anterior Cruciate Ligament Reconstruction Among Commercially Insured Patients in the United States, 2005-2013. / Herzog, Mackenzie M.; Marshall, Stephen W.; Lund, Jennifer L.; Pate, Virginia; Spang, Jeffrey T.

In: Orthopaedic Journal of Sports Medicine, Vol. 5, No. 1, 27.01.2017.

Research output: Research - peer-reviewArticle

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