Return on investment of anterior cruciate ligament injury prevention programs in the United States
ACL tears in high school athletes represent a significant health and economic burden. This study compares the cost-benefit of implementing injury prevention programs (IPPs) versus standard warm-ups for ACL injuries in U.S. high school soccer players.
College of Health researcher(s)
Highlights
- Strong Financial Return: For every $1 spent on implementing IPPs nationally, approximately $7.51 would be saved in medical costs related to ACL injuries.
- Substantial Total Savings: A nationwide implementation for high school soccer would cost about $10 million but could prevent over $76 million in medical costs, resulting in net savings of more than $60 million.
- Different Results by Insurance Type: Prevention programs were highly profitable for private insurance companies (saving $6.60 per dollar spent) but not for public insurance programs like Medicaid (saving only $0.92 per dollar spent).
- Minimal Effectiveness Needed: Even if prevention programs reduced ACL injury risk by just 7% (much lower than the 50% reduction typically observed in studies), the programs would still break even financially.
- Scale Matters But Isn't Essential: Even implementing programs at smaller scales, such as school districts or counties, could be financially viable.
Abstract
Context
Anterior cruciate ligament (ACL) tears represent a significant health and economic burden in high school athletes. Despite evidence showing lower extremity injury prevention programs (IPPs) are effective at preventing ACL injury, IPPs lack widespread adoption.
Objective
Compare the cost-benefit of implementation of an injury prevention program versus standard warm-up in a national high school soccer population using a health system perspective.
Design
Cost Benefit Analysis.
Setting
Simulation of nationwide implementation of an IPP for United States high school soccer players.
Patients or Other Participants
Data for high school soccer players from the 2018-2019 season.
Main Outcome Measure(s)
Return on investment was calculated using the cost of ACL treatment prevented with IPP use and the cost of IPP implementation.
Results
IPP implementation was the preferred strategy with a return on investment of $7.51 saved in ACL treatment costs prevented for every dollar spent on IPP implementation in our full model. When separating analysis by insurance type, private payors continued to show profitability while public payors failed to break even. The total net monetary benefit was over $60 million when simulating national-level IPP implementation.
Conclusions
IPP implementation has the potential to generate significant medical cost savings in short-term ACL treatment costs, especially for private payors, when implemented in a national high school soccer population. The expected cost-benefit of IPPs should encourage broader implementation efforts and the inclusion of economically relevant stakeholders.
Frequently Asked Questions about ACL Injury Prevention Programs
What are Injury Prevention Programs (IPPs) and how do they aim to reduce ACL injuries?
Injury Prevention Programs (IPPs) are multicomponent training programs designed to reduce the risk of lower extremity injuries, including ACL tears. They typically involve a combination of strength, plyometrics, agility, and flexibility exercises, coupled with feedback on movement technique. These programs are often implemented in place of a standard warm-up routine. Studies have shown that IPPs can reduce the risk of ACL tears in athletes by 51-85%.
What was the main objective of this study?
The study aimed to compare the cost-benefit of implementing an IPP versus a standard warm-up at a national level in a high school soccer population, using a health system perspective. The study hypothesized that national-level implementation of IPPs would be the favored strategy. It sought to inform resource allocation and incentive structures for policymakers and stakeholders to advance IPP implementation.
What were the main findings of the cost-benefit analysis?
The study found that IPP implementation was the preferred strategy, showing a return on investment (ROI) of $7.51 saved in ACL treatment costs for every dollar spent on IPP implementation in the full model. Private payors showed profitability with IPP implementation, while public payors failed to break even. The total net monetary benefit was over $60 million when simulating national-level IPP implementation.
How was the return on investment (ROI) calculated in this study?
The return on investment (ROI) was calculated by dividing the medical costs (surgical and conservative treatment costs) prevented with IPP use by the cost of IPP implementation. The ROI was calculated for all payors, public payors only, and private payors only.
What impact does insurance type (public vs. private) have on the cost-benefit of IPP implementation?
The study found that IPP implementation was profitable when funded only by private payors, but not when funded only by public payors. This is attributed to lower reimbursement rates from Medicaid, a smaller proportion of athletes with public insurance, and a reduced rate of surgical treatment for publicly insured athletes. Sensitivity analysis showed that increasing the rate of surgical treatment for publicly insured athletes could allow public payors to break even.
What is the "need to treat" value and what does it signify in this context?
The "need to treat" value refers to the number of athletes who need to participate in an IPP to prevent one ACL injury. In this study, the need to treat value was 111 athletes in the all-payor model. This value helps to understand the scale at which IPPs need to be implemented to achieve cost savings.
What were some of the limitations of this study?
Limitations included a lack of specific data on insurance type for high school soccer athletes and ACL reconstruction rates by insurance type. The study also used cost estimates and proportions from the general population ages 6-17, which may not accurately reflect the high school soccer athlete population. The long-term burden of ACL injuries (like osteoarthritis) was not accounted for.
What are the implications of this study for policy and future research?
The study suggests that IPP implementation has the potential to generate significant medical cost savings, especially with private payors, and encourages broader implementation efforts. It also highlights the opportunity for public-private partnerships to reduce the burden of ACL injuries. Future research should account for additional costs related to ACL injuries, implementation costs in real-world settings, and the role of stakeholder engagement in promoting IPP adoption. The study also suggests that policies should be put in place to make IPP education a part of coaching licensure.