Romy Deviandri,1– 3 Hugo C van der Veen,1 Andri MT Lubis,4 Ghuna A Utoyo,5 Inge van den Akker-Scheek,1 Maarten J Postma6– 9 1Department of Orthopedic Surgery, University of Groningen/ University Medical Center Groningen, Groningen, the Netherlands; 2Department of Physiology-Faculty of Medicine, Universitas Riau, Pekanbaru, Indonesia; 3Department of Orthopedics-Sports Injury, Arifin Achmad Hospital, Pekanbaru, Indonesia; 4Department of Orthopedics-Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia; 5Department of Orthopedics-Faculty of Medicine, Universitas Padjadjaran/ Hasan Sadikin Hospital, Bandung, Indonesia; 6Department of Health Sciences, University of Groningen/ University Medical Center Groningen, Groningen, the Netherlands; 7Department of Economics-Faculty of Economics & Business, University of Groningen, Groningen, the Netherlands; 8Department of Pharmacology & Therapy, Universitas Airlangga, Surabaya, Indonesia; 9Department Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, IndonesiaCorrespondence: Romy Deviandri, Department of Orthopedic Surgery, University of Groningen/ University Medical Center Groningen, Hanzeplein 1, Groningen, 9713 GZ, the Netherlands, Email r.deviandri@rug.nl; romydeviandri@lecturer.unri.ac.idObjective: The number of anterior cruciate ligament reconstruction (ACLR) procedures is increasing. However, ACLR procedures are likely to be underbudgeted in a developing country like Indonesia. This study aimed to analyze costs for ACLR procedures in Indonesia’s resource-limited context, determine the burden of ACLR, and suggest national prices for ACLR reimbursement.Methods: A retrospective observational study was conducted between 1 January and 31 December 2019 on the cost of ACLR from a payer perspective using inpatient billing records in four hospitals. The national burden of ACLR was calculated, and projected national prices for reimbursement were determined.Results: Of 80 ACLRs, 53 (66%) were isolated ACLRs and 27 (34%) ACLRs were combined with meniscus treatment. Mean hospital costs incurred per ACLR procedure were US$ 2853, with the dominant cost relating to orthopedic implant prices (US$ 1,387.80). The costs of ACLR with combined meniscus treatment were estimated as being 35% higher than isolated ACLR. The national burden of ACLR showed a total budget of US$ 367.4 million per 100,000 patients (0.03% of GDP) for ACLR with additional meniscus treatment and US$ 271.3 million per 100,000 patients (0.02% of GDP) for isolated ACLR.Conclusion: ACLR procedures in Indonesia are likely underbudgeted. Adjustments of reimbursement prices for ACLR are needed to facilitate adequate access of Indonesians to the procedures. This study demonstrated varying costs determined for ACLR in Indonesia, which entails that a new reimbursement system with improvement of national prices should become the core of transformation.Keywords: ACL tear, meniscus injury, cost, developing countries, BPJS