This study indicated that bone-anchored prostheses might be an acceptable alternative to socket-suspended prostheses at least from a prosthetic care perspective in Australian context. Altogether, this initial evidence-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 evidence-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.

Introduction This observational study compared historical costs for provision of socket prostheses with simulated costs for bone-anchored prostheses (BAPs). Materials and Methods The costs of transfemoral socket prostheses and BAP were extracted from the Queensland Artificial Limb Service's regulatory documentation according to K-levels and estimated for low-cost, budget, and high-cost limb options. Total costs including labor and parts after 6-year funding cycles were cross-compared for each socket and BAP fitting option. Results Labor and attachment costs were reduced by 18% and 79%, respectively, for all BAP options compared with any socket fitting. BAP was more economical by $18,200, $7,000, and $1,600 when fitted with low-cost, budget, and high-cost options, respectively, compared with sockets for K4. The low-cost limb was the only economical option compared with all sockets above K2. Other BAP options were uneconomical compared with socket fitting below K4. Discussion Suppliers of conventional prosthetic components can strongly impact the overall costs. Interestingly, manufacturers of BAP could play a decisive role given the cost of specific parts (e.g., connectors, protective devices). Conclusions The proposed approach for cost assessments could assist funding organizations worldwide working toward the development of fair and equitable financial assistance programs for individuals choosing BAP.

Introduction. This initial cost-effectiveness evaluation compared the provision of transtibial bone-anchored prostheses (TTA-BAP) with socket-suspended prostheses (TTA-SSP) over a six-year time horizon from a governmental prosthetic care perspective. The purposes were to present ways we dealt with barriers encountered during the cost-effectiveness analysis. The objectives were to detail the extraction of baseline and incremental costs and utilities required to provide preliminary incremental cost effectiveness ratios (ICERs) per quality-adjusted lifeyear (QALY). Materials and Methods. This retrospective case-series study involved six participants fitted consecutively with TTA-SSP and TTA-BAP. Total costs combined actual and typical costs extracted from financial records and a schedule of allowable expenses, respectively. Baseline utilities were extracted from the literature while incremental utilities were assumed. Results. ICERs ranged between -$25,065 and $41,929 per QALY. Indicative ICER was approximately $11,400 per QALY. Provision of TTA-BAP was cost-effective and cost-saving for 83% and 33% of cases, respectively. Discussion. Educated choices were required to overcome unavailability of individual costs (e.g., creation of schedule of allowable expenses, blending of actual and typical costs) and utilities (e.g., extraction of baseline from literature, assumptions for incremental gain). Indicative ICER might lead to adoption of TTA-BAP, at least from an Australian governmental prosthetic care perspective.