Cost-effectiveness of osseointegrated prostheses

Frossard L, Merlo G, Burkett B, Quincey T, Berg D. Cost-effectiveness of bone-anchored prostheses using osseointegrated fixation: myth or reality? Prosthetics and Orthotics International. 2018. 42 (3). p 318-327

Abstract: Study Design. Retrospective individual case-controlled observations and systematic review. Background. In principle, lower limb bone-anchored prostheses (BAP) could alleviate expenditure associated with typical socket manufacturing and residuum treatments due to socket-suspended prostheses (SSP). Objective. This study reports (A) the incremental costs and (B) heath gain as well as (C) cost-effectiveness of BAP compared to SSP. Methods. Actual costs were extracted from financial records and completed by typical costs when needed over six-year time horizon for a cohort of 16 individuals. Health gains corresponding to quality-adjusted life-year (QALY) were calculated using health-related quality of life data presented in the literature. Results. The provision of BAP costed 21±41% more but increased QALYs by 17±5% compared to SSP. The incremental cost effectiveness ratio (ICER) ranged between -$25,700 per QALY and $53,500 per QALY with indicative ICER of approximately $17,000 per QALY. BAP was cost-saving and cost-effective for 19% and 88% of the participants, respectively. Conclusions. This study indicated that BAP might be an acceptable alternative to SSP at least from a prosthetic care perspective in Australian context. Altogether, this initial evidenced-based economic evaluation provided a working approach for decision makers responsible for policies around care of individuals with lower limb amputation worldwide. Clinical relevance. For the first time, this study provided evidenced-based health economic benefits of lower limb bone-anchored prostheses compared to typical socket-suspended prostheses from a prosthetic care perspective that is essential to clinicians and decision makers responsible for policies around care of individuals with transfemoral limb amputation worldwide.