When evaluating preventive measures, we tend to focus on injury rates - more specifically, a reduction in injury rates - as the main outcome of interest. However, other outcomes may be needed to highlight, for instance, the benefit of an intervention at a policy level. Therefore, this systematic review analysed economic evaluations of sports injury prevention programmes.
In brief
Sports injuries lead to short-term and long-term negative effects on athletes’ health and are associated with high direct and indirect costs.
Various preventive measures for sports injuries have been developed over the last years; the associated reduction in injuries has been demonstrated several times.
Available studies show that preventive measures reduce both injury rates and costs. In particular, prevention concepts with specific training interventions reduce costs.
The analysis of the economic impact of injuries in professional sports is limited; there is a need to develop and implement further sports injury prevention strategies and include economic considerations.
Methods
We searched PubMed and SportDiscuss for economic analyses published since 2010. Studies investigating economic evaluations of preventive measures in sports injury prevention (defined by investigating one or more preventive measures and including both costs and effects) were included. Studies had to be written in English and published either online or in print in a peer-reviewed journal. Except for meeting abstracts and proceedings, all available evidence for economic evaluation was considered for inclusion.
The methodological quality of the studies was assessed using the Oxford Level of Evidence for economic and decision analysis; underlying randomised controlled trials (RCTs) were rated according to the Physiotherapy Evidence Database (PEDro) scale, and risk of bias was assessed using the Revised Cochrane risk-of-bias tool.
Results
Ten studies fulfilled the inclusion criteria. The quality assessment revealed limited data quality. For trial-based analysis, underlying RCTs were of good quality and had a low risk of bias. Prevention concepts for general injury reduction showed the effectiveness and cost savings. Regarding specific injury types, the analysis of the studies showed that the best data are available for ankle, hamstring and anterior cruciate ligament injuries. Measures using specific training interventions were the predominant form of prevention concepts; studies investigating these concepts showed cost-effectiveness with total cost savings between euro24.82 and euro462 per athlete.
Conclusion
Injury prevention strategies that were studied are cost-effective. However, estimates and outcomes vary throughout the included studies and precluded pooling of existing data. Knowledge about the cost-effectiveness of evaluated prevention measures will help improve the acceptance and application of prevention initiatives.
The full paper can be found here (paid access)
Lutter C, Jacquet C, Verhagen E, Seil R, Tischer T. Does prevention pay off? Economic aspects of sports injury prevention: a systematic review. Br J Sports Med Epub ahead of print. doi:10.1136/ bjsports-2021-104241