Does prevention pay off? Economic aspects of sports injury prevention: a systematic review


Christoph Lutter 1, Christophe Jacquet 2, 3, Evert Verhagen 4,

Romain Seil 2, 3, Thomas Tischer 1

1 - Department of Orthopedics, University Medical Center Rostock, Rostock, Germany

2 - Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d'Eich, Luxembourg, Luxembourg

3 - Luxembourg Institute of Health, Luxembourg, Luxembourg

4 - Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, University Medical Centers – Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

Link to the article


Objective To identify, summarise and critically assess economic evaluation studies on sports injury prevention strategies.

Design Systematic review.

Data sources PubMed, SportDiscuss.

Eligibility criteria for selecting studies

The current literature was searched following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Economic analyses published since 2010 were checked 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.


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 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 €24.82 and €462 per athlete.


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.