Return on investment of anterior cruciate ligament injury prevention programs in the United States.

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.