Economic Evaluations of Interventions For Transtibial Amputees: A Scoping Review of Comparative Studies

Abstract

Transtibial amputation (TTA) is life-altering emotionally, functionally, and economically. The economic impact to all stakeholders is largely unknown, as is the cost-effectiveness of prosthetic intervention. This scoping report’s purpose was to determine if there is sufficient evidence to conduct a formal systematic review or meta-analysis in any particular prosthetic intervention area and to determine if any evidence statements could be synthesized relative to economic evaluation of interventions provided to patients with TTA. The scoping review revealed six articles representing three topical areas of transtibial care: Care Models, Prosthetic Treatment, and Prosthetic Sockets. All six articles were cost-identification or cost-consequence design and included a total of 704 subjects. Presently, it can be concluded with moderate confidence that specific weight-bearing and total-contact sockets for transtibial amputees are functionally and economically equivalent in the short term when costs, delivery time, and all stakeholder perspectives are considered. Long-term socket outcomes are relatively unexplored. Further primary research is needed beyond this to determine cost-effectiveness for other areas of transtibial prosthetic care although clinical outcomes are somewhat established through systematic review and meta-analysis in other areas of care. Conversely, evaluation of narrative economic reports relative to transtibial care may be sufficient to warrant further analysis. Guidance from the profession may also be useful in devising a strategy for how to assure economic analyses are a routine element of future prosthetic science.

Impact of Time to Receipt of Prosthesis on Total Healthcare Costs 12 Months Postamputation

“…The information deficits in this area have been discussed in recent articles, for example, in the RAND report on transfemoral economics and a literature review by Highsmith et al on transtibial prosthesis economics. 7 , 31 More detailed information on the timing of prosthesis receipt will continue to assist informing key stakeholders including physicians and payer sources on the benefits of early referral and delivery of a device anchored to a specific time, such as within 3 mos post-LLA.…”

“…With increasing pressure from payers to provide health services more efficiently and effectively, evidence to demonstrate and describe the effect of prosthetic rehabilitation is crucial. 7 , 8 …”

“… 9 – 11 Furthermore, a shorter time from amputation to prosthesis delivery may result in a more active and sustained recovery. 7 …”

The role of exercise testing in predicting successful ambulation with a lower extremity prosthesis: a systematic literature review and clinical practice guideline

“…A criticism of this study design may be that the systematic literature review without meta-analysis should not constitute the basis for a CPG. However, descriptive literature reviews have been used as the basis for clinical practice recommendations in the field of endoskeletal prosthetics as the literature base is currently limited compared to other healthcare fields [ 9 , 11 , 13 ]. Meta-analysis was considered in the early stages of this project, but the heterogeneity of outcome measures in terms of modality, intensity, and continuity limited the clinical meaningfulness of any results.…”

Economic value of orthotic and prosthetic services among medicare beneficiaries: a claims-based retrospective cohort study, 2011–2014

“…Orthotic and lower extremity prosthetic devices and related clinical services are designed to provide patients with stability and mobility. While the literature contains considerable evidence of geographic variation in both major amputation rates and the use of orthotic and prosthetic (O&P) services [ 1 – 3 ], there are limited studies of the extent to which beneficiaries who receive O&P services experience a reduction in complications and/or costs with favorable outcomes [ 4 ].…”