A Preliminary Cost-Utility Analysis of the Prosthetic Care Innovations: Case of the Keep Walking Implant

Abstract

Several obstacles must be overcome before preliminary cost-utility analyses (CUA) of prosthetic care innovations can be routinely performed. The basic framework of preliminary CUAs and hands-on recommendations suggested previously might contribute to wider adoption. However, a practical application for an emerging intervention is needed to showcase the capacity of this proposed preliminary CUA framework. This study presented the outcomes of preliminary CUA of the distal weight bearing Keep Walking Implant (KWI), an emerging prosthetic care innovation that may reduce socket fittings for individuals with transfemoral amputation. The preliminary CUAs compared the provision of prosthetic care without (usual intervention) and with the KWI (new intervention) using a 15-step iterative process focused on feasibility, constructs, analysis, and interpretations of outcomes from an Australia government prosthetic care perspective over a six-year time horizon. Baseline and incremental costs were extracted from schedules of allowable expenses. Baseline utilities were extracted from a study and converted into quality-adjusted life-year (QALY). Incremental utilities were calculated based on sensible gains of QALY from baselines. The provision of the prosthetic care with the KWI could generate an indicative incremental cost-utility ratio (ICUR) of -$36,890 per QALY, which was $76,890 per QALY below willingness-to-pay threshold, provided that the KWI reduces costs by $17,910 while increasing utility by 0.485 QALY compared to usual interventions. This preliminary CUA provided administrators of healthcare organizations in Australia and elsewhere with prerequisite evidence justifying further access to market and clinical introduction of the KWI. Altogether, this work suggests that the basic framework of the preliminary CUA of a prosthetic care innovation proposed previously is feasible and informative when a series of assumptions are carefully considered. This study further confirms that preliminary CUAs prosthetic care interventions might be a relevant alternative to full CUA for other medical treatments.
 Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/36366/28329
 How To Cite: Guirao L, Samitier B, Frossard L. A preliminary cost-utility analysis of the prosthetic care innovations: case of the keep walking implant. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, No.11. https://doi.org/10.33137/cpoj.v4i2.36366
 Corresponding Author: Laurent Frossard (PhD), Professor of BionicsYourResearchProject Pty Ltd, Brisbane, Australia.E-Mail: laurentfrossard@outlook.comORCID number: https://orcid.org/0000-0002-0248-9589

Editorial: Bionics limb prostheses: Advances in clinical and prosthetic care

“…Robust evidence will be required to overcome what Harris (2016) described as the "decline effect" (e.g., Initial strong results of new treatments tend to fade overtime with subsequent independent and stronger studies) (60). This will be critical to convince public and private healthcare funding bodies to support a particular innovation, particularly with the emergence of the fee-for-device business model (e.g., hospital, work cover, and insurance) (25)(26)(27)(28)(29)(30).…”

“…Pain leads to frequent, and too often permanent, prosthesis abandonment (22)(23)(24). Altogether, repeated episodes of care addressing prosthetic fitting generate great personal distress and heavy socioeconomic burdens (e.g., healthcare expenses and work absenteeism) (25)(26)(27)(28)(29)(30).…”

Health Service Delivery and Economic Evaluation of Limb Lower Bone-Anchored Prostheses: A Summary of the Queensland Artificial Limb Service’s Experience

“…More importantly, these publications were considered and often cited in recent health technology assessments of osseointegrated prosthetic solutions produced by several government organizations (e.g., Australian states, Canadian provinces, United Kingdom, New Zealand, Spain). [34][35][36][37][38][39][40] This work provided guidance when the Australian National Disability Insurance Scheme developed its funding model.…”

“…• Sort out schedules for allowable expenses. The adequate allocation of allowable hours to support the provision of BAP-specific prosthetic care was initially 39 However, the loss of income could be compensated by fitting BAP with high-end components.…”

“…These analyses were conducted following an initial version of the 15-step iterative process (e.g., feasibility, constructs, analysis, interpretation) presented by Frossard et al (2021). 38 , 39 Both preliminary CUAs of transfemoral and transtibial BAPs were performed for a small series of plausible scenarios over a six-year time horizon from the government perspective. 16 , 18 An overview of our approach to collect, extract, and analyze estimates of costs and utilities is presented in Figure 5 .…”