Cost-Effectiveness of Transtibial Bone-Anchored Prostheses Using Osseointegrated Fixation: From Challenges to Preliminary Data

Abstract

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.

Trends and Opportunities in Health Economic Evaluations of Prosthetic Care Innovations

“…12,13, 29,86 Altogether, organisation of the delivery and assessment of prosthetic care might be sufficiently transferable across innovations to consider a more uniform approach to preliminary CUAs. [50][51][52] constructs (e.g., perspective, time horizon, discount) and practical recommendations (e.g., funding cycles) specific to preliminary CUAs of the prosthetic care innovations (APPENDIX 1). This new approach to a preliminary CUA has the potential to simplify the selection of methods, standardise outcomes, ease comparisons between innovations and streamline pathways for adoption while facilitating the production of a body of literature on prosthetic health economics.…”

A Preliminary Cost-Utility Analysis of the Prosthetic Care Innovations: Basic Framework

“…Such a framework should be built based on fundamentals, applied principles of health economics, and recent preliminary CUAs of socketfree attachment for transfemoral and transtibial prostheses. 7,8,14 The primary purpose of this article was to introduce a basic framework including a 15-step iterative process focusing on feasibility, constructs, analysis, and interpretations of outcomes of a preliminary CUA of prosthetic care innovations. Practically, a series of constructs and handson ways to gather information was presented.…”

“…The ICUR is based on the incremental costs expressed in monetary units and utilities expressed in quality-adjusted life-year (QALY) over time compared to the willingness-to-pay threshold (WTP). [4][5][6][7][8][9] As detailed in Frossard (2021), early, preliminary, and full CUAs can be conducted at the early, middle, and late phases of product development and clinical acceptance of innovations, respectively. 3 Full CUAs, including primary and modeling analyses, can produce comprehensive outcomes, but they require substantial resources and lack timeliness.…”

“…2, No.10. https://doi.org/10.33137/cpoj.v4i2.36365 between three and five realistic scenarios including, the best, base, and worse cases depending on foreseeable costs and utility consequences of the innovation 7,8. …”

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

“…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).…”