The economics of a national anterior cruciate ligament injury prevention program for amateur football players: a Markov model analysis

Objectives: To estimate the long term cost savings, return on investment, and gain in quality-adjusted life years (QALYs) that could be achieved by a national anterior cruciate ligament (ACL) injury prevention program for amateur football (soccer) players in Australia. Study design: Markov model decision analysis. Setting, participants: Two hypothetical scenarios including all amateur football players in Australia (340 253 players): no intervention, and a national ACL injury prevention program. Transitions between health states, including ACL rupture, meniscal injury, knee osteoarthritis, and total knee replacement were made in one-year cycles over 35 years from a societal perspective. Main outcome measures: Cost savings, return on investment, and QALY gain achieved in the prevention program scenario relative to control scenario, by age group (10–17, 18–34, 35 years or older) and gender. Secondary outcomes: incidence of ACL rupture, knee osteoarthritis, total knee replacement, and total knee replacement revision. Results: The total mean cost of an ACL injury was estimated to be $30 665. The national injury prevention program was projected to save $52 539 751 in medical and societal costs caused by ACL ruptures in amateur footballers over 35 years; the estimated return on each dollar invested in the program was $3.51. Over this period, the number of players with ruptured ACLs could be reduced by 4385 (9%), the number of knee osteoarthritis cases by 780 (8.1%), and the number of total knee replacements by 121 (8.1%); 445 QALYs were gained. Conclusion: Our findings support investing in a national, evidence-based program for the primary prevention of ACL injuries in amateur football players.