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Relevant transition probabilities, costs (in 2019 US dollars based on Medicare reimbursement), health state utilities, and times to healing were derived from the literature. The principal outcome measure was the incremental cost\u2010effectiveness ratio (ICER). One\u2010 and 2\u2010way sensitivity analyses were performed on pertinent model parameters to validate the robustness of the base\u2010case results using a conservative willingness\u2010to\u2010pay (WTP) threshold of $50,000 per quality\u2010adjusted life\u2010year (QALY). The Consolidated Health Economic Evaluation Reporting Standards checklist for reporting economic evaluations was used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the base\u2010case analysis from a payer perspective, early drilling was more effective (2.51 versus 2.27 QALYs), more costly ($4,655 versus $3,212), and overall more cost\u2010effective (ICER $5,839\/QALY) relative to nonoperative management. In the base\u2010case analysis from a societal perspective, early drilling dominated nonoperative management owing to its increased effectiveness (2.51 versus 2.27 QALYs) and decreased cost ($13,098 versus $18,149). These results were stable across broad ranges on sensitivity analysis. Based on 1\u2010way threshold analyses from a payer perspective, early drilling remained cost\u2010effective as long it cost less than $19,840, the disutility of surgery was greater than \u20130.40, or the probability of successful early drilling was greater than 0.62.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although the traditional approach to stable OCD lesions of the knee in skeletally immature patients has been a trial of nonoperative management, our data suggest that early drilling may be cost\u2010effective from both payer and societal perspectives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>III, economic and decision analysis.<\/jats:p>\n                  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