No difference in cost and effects between an app-based and paper-based injury prevention program

It has been a bit quiet lately, but we have not been laying back. Just released in the Scandinavian Journal of Medicine & Science in Sports, our cost-effectiveness analysis that compares a mobile App versus a paper-based injury prevention program.

Recurrent ankle sprains can be reduced by following a neuromuscular training (NMT) program. In this economic analysis, we evaluated whether the method of implementing a proven effective NMT program using an App or a Booklet resulted in differences in injury incidence rates and costs, and hence to differences in cost-effectiveness.

In total, 220 athletes with a previous ankle sprain were recruited for this randomized controlled trial with a follow-up of 12 months. Half of the athletes used the freely available “Strengthen your ankle” App and the other half received a printed Booklet which is the current standard way of providing the intervention. After the 8-week program, athletes were questioned monthly on their recurrent injuries. Primary outcome measures were incidence density of ankle injury and the incremental cost-effectiveness ratio (ICER).

 Cost-effectivenessplane presenting cost-effect pairs estimatedusing bootstrapping (1000 samples) for the difference in ankle sprain recurrence risk between the App group and the Booklet group. Each dot represents one bootstrapped cost-effect pair and the difference in costs and effects of the App group compared to the Booklet group. The outcomes of the samples are spread over the four quadrants, with only 38% of the bootstrapped cost- effect pairs in the south-east “dominant” quadrant 

Cost-effectivenessplane presenting cost-effect pairs estimatedusing bootstrapping (1000 samples) for the difference in ankle sprain recurrence risk between the App group and the Booklet group. Each dot represents one bootstrapped cost-effect pair and the difference in costs and effects of the App group compared to the Booklet group. The outcomes of the samples are spread over the four quadrants, with only 38% of the bootstrapped cost- effect pairs in the south-east “dominant” quadrant 

During follow-up, 31 athletes suffered a recurrent ankle sprain that led to costs resulting in a non-significant hazard ratio between groups of 1.13 (95% CI: 0.56-2.27). The incremental cost-effectiveness ratio of the App group in comparison with the Booklet group was €361.52. The CE plane shows that there was neither a difference in effects nor in costs between both intervention methods. From these results we concluded that both the App and the Booklet can both be used to prevent recurrent ankle injuries, showing no differences in (cost-) effectiveness after 12-month follow-up. 

The full article can be found here.

van Reijen M, Vriend II, van Mechelen W, et al. Preventing recurrent ankle sprains: Is the use of an App more cost-effective than a printed Booklet? Results of a RCT. Scand J Med Sci Sports 2018;28:641–8.