Abstract
Health Region 7th has developed strategies to build up and enhance capacity for medical services in orthopedic at the M1 level hospital. This study was aimed to assess cost utility of arthroscopic knee surgery in patients who had anterior cruciate ligament injury with or without meniscus injury at M1 hospital level as compared to the operation performed at only the provincial hospital level. The present study was based on decision tree analysis with the time horizon of 1 year using a societal perspective. The primary data collection was performed to obtain the following key variables: waiting time, complication rate, return to sport outcome (up to 1 year), direct medical cost, direct nonmedical cost, indirect cost, and utility (EuroQoL-EQ-5D-5L). The study sites included Sirindhorn Hospital (M1 level) and Khon Kaen Hospital (provincial hospital). The training cost and cost of instruments were 99,328 Baht. At Sirindhorn and Khon kaen hospitals, proportions of patients undergone surgery within 2 months were 93% and 25%, and the averages of waiting time were 1.03 ± 0.67 and 4.3 ± 3.0 months, respectively. The complication rates were similar of 7%. All patients with or without complications could return to sport within 1 year. Utilities at baseline, after surgery, 3, 6, 12 months thereafter were 0.66±0.15, 0.77±0.22, 0.92±0.07, 0.93±0.06 respectively. Under the timeframe of 1 year, direct medical cost, direct non-medical cost, and indirect cost for one case were 19,215, 7,488, and 1,479 Baht at Sirindhorn Hospital and 19,413, 7,888, and 1,538 Baht at Khon Kaen Hospital. For one case, total costs were 31,493 and 28,839 Baht, and quality-adjusted life years were 0.91 and 0.85, respectively. An incremental cost effectiveness ratio was 41,058 Baht/Quality adjusted life year. In conclusion, arthroscopic knee surgery for anterior cruciate ligament injury at M1 hospital level could reduce waiting time and was cost effective as compared to the operation performed at the provincial hospital level. The complication rates were similar and relatively low. All patients with and without complications in both hospitals could return to sport within 1 year. The policy recommendation proposes that provision of orthopedic services at the M1 hospital level should be promoted for the procedures that complication rates were similar and relatively low in both levels, complications do not lead to the final clinical outcomes, post-treatment utility outcome would increase by 0.24 (EQ5D 5L), and waiting time should not be greater than 2 months. The procedure as such would be cost-effectiveness if the initial program cost is about 662 Baht per one case.
