Cost-Utility Analysis of Reconstruction Compared With Primary Amputation for Patients With Severe Lower Limb Trauma in Colombia

Ceballos, Mateo; Valderrama, Carlos; Orozco, Luis E.; Sánchez, Laura Estefany Ruiz; Valderrama, Juan P.; Lugo, Luz Helena

doi:10.1097/bot.0000000000000883

Cited by 4 publications

(7 citation statements)

References 17 publications

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“…[5][6][7] The financial impact of injury at the society level has been shown to be large. [8][9][10] However, it is not yet understood how the financial burden of injury affects individuals from the patient perspective.…”

Section: Introductionmentioning

confidence: 99%

Financial Toxicity Is Common in Patients After Tibia Fracture

Mundy

Zingas

McKibben

et al. 2023

Journal of Orthopaedic Trauma

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Setting: Level I trauma center.Patients: All patients within 4 years after tibial shaft fracture (open, closed, or fracture that required flap reconstruction).Intervention: Injury-related financial distress.Main Outcome Measurements: Financial distress related to the injury, as reported by the patient in a binary question. Financial toxicity using the LIMB-Q, scored from 0 to 100, with higher scores indicating more financial toxicity.Results: Data were collected from 142 patients after tibial shaft fracture [44% closed (n = 62), 41% open (n = 58), and 15% flap (n = 22)]. The mean age was 44 years (SD 17), 61% were men, and the mean time from injury was 15 months. Financial distress was reported by 64% of patients (95% confidence interval, 56% to 72%). Financial toxicity did not differ by fracture severity (P = 0.12). Medical complications were associated with a 14-point increase in financial toxicity (P = 0.04). Age older than 65 years (215 points, P = 0.03

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Section: Introductionmentioning

confidence: 99%

Financial Toxicity Is Common in Patients After Tibia Fracture

Mundy

Zingas

McKibben

et al. 2023

Journal of Orthopaedic Trauma

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“…The results of the first economic evaluation concluded that, after a careful selection of patients and intervention by a multidisciplinary team, limb reconstruction was a dominant strategy compared to primary amputation in the long term ( 23 ).…”

Section: Resultsmentioning

confidence: 99%

Development of a Clinical Practice Guideline for Lower Limb Amputees. A Knowledge Translation Process in a Middle Income Country

Borrero

Patiño-Lugo

Plata-Contreras

et al. 2022

Front. Rehabilit. Sci.

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Background and AimKnowledge translation processes are necessary for improving patients' and communities' health outcomes. The aim of this study was to systematically develop evidence-based recommendations for people over 16 years of age who are in risk for or have suffered a lower limb amputation for medical reasons (vascular, diabetes mellitus) or trauma (civilian or military trauma) in order to improve function, quality of life, decrease complications and morbidity.MethodsFollowing the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach we developed a Clinical Practice Guideline (CPG) for lower limb amputees with funding from the Ministry of Health in Colombia and participation of a multidisciplinary group. We included patients' preferences. Based on the scope, purposes and objectives the questions were elaborated with the PECOT strategy. The evidence search was performed for each question in the main databases: Cochrane Library, Embase and PubMed, without time limit or language restriction. Teams were formed with thematic experts and clinical epidemiologists to review the clinical studies, describe the evidence, and evaluate the quality of the body of evidence with the GRADE methodology. The recommendations were made according to the judgments proposed by the GRADE working group. We conducted a stakeholder's dialogue as a mechanism for the external validation of the guideline implementation.ResultsThe CPG included 43 recommendations related to the diagnosis, surgical treatment, rehabilitation, prescription and adaptation of the prosthesis. They were strong in favor 37.2, weak in favor 53.5, strong against 2.3, Weak against 7.0%. Quality of evidence was high in 0, moderate in 11.6, low in 58.1, and very low 30.2%.DiscussionIn 93% of the recommendations, the quality of the evidence was between low and very low. This is why it was so important to validate and discuss each recommendation with an expanded multidisciplinary group. The research group identified 25 interventions and five milestones to be prioritized in the implementation and in the stakeholder's dialogue participants identified opportunities and barriers for implementation of recommendations.ConclusionIt is necessary to develop a national policy for implementation strategies of CPG recommendations that promotes the necessary arrangements for the provision of services for diagnosis, treatment, and rehabilitation of individuals with amputations.

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“…Table 3: Overview of the 14 utility scores providing a generic baseline utility of 0.67 per QALY extracted from eight publications comparing health states associated foot or leg wounds and lower limb amputation for three populations using a range of methods from various perspectives. [53][54][55][56][57][58][59][60] Figure 1. Overview of data flow for collection, extraction and analysis of cost (Datasets), utility (Scenarios) and cost-utility data from a prosthetic care perspective (TTA: Transtibial amputation, TFA: Transfemoral amputation, SSP: Socket-suspended prosthesis, BAP: Bone-anchored prosthesis, QALY: Quality-adjusted lifeyear, ICER: Incremental cost-effectiveness ratio, CET: Cost-effectiveness threshold).…”

Section: Discussionmentioning

confidence: 99%

“…Overview of data flow for collection, extraction and analysis of cost (Datasets), utility (Scenarios) and cost-utility data from a prosthetic care perspective (TTA: Transtibial amputation, TFA: Transfemoral amputation, SSP: Socket-suspended prosthesis, BAP: Bone-anchored prosthesis, QALY: Quality-adjusted lifeyear, ICER: Incremental cost-effectiveness ratio, CET: Cost-effectiveness threshold). [53][54][55][56][57][58][59][60] Figure 2. Overview of cost-effectiveness analysis using indicative ICER of $11,453 per QALY and costeffectiveness threshold (CET) of $40,000 per QALY with quadrant for bone-anchored prosthesis more costly and more effective (1), more costly and less effective (2), less costly and less effective (3), less costly and more effective (4) than socket-suspended prosthesis.…”

Section: Discussionmentioning

confidence: 99%

“…Overview of data flow for collection, extraction, and analysis of cost (data sets), utility (scenarios), and cost-utility data from a prosthetic care perspective (TTA, transtibial amputation; TFA, transfemoral amputation; SSP, socket-suspended prosthesis; BAP, bone-anchored prosthesis; QALY, quality-adjusted life-year; ICER, incremental cost-effectiveness ratio 30 ; CET, cost-effectiveness threshold). [47][48][49][50][51][52][53][54] Frossard et al…”

Section: Estimation Of Costsmentioning

confidence: 99%

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

et al. 2021

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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.

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Cost-Utility Analysis of Reconstruction Compared With Primary Amputation for Patients With Severe Lower Limb Trauma in Colombia

Abstract: Economic Level II. See Instructions for Authors for a complete description of levels of evidence.

Cited by 4 publications

References 17 publications

Financial Toxicity Is Common in Patients After Tibia Fracture

Financial Toxicity Is Common in Patients After Tibia Fracture

Development of a Clinical Practice Guideline for Lower Limb Amputees. A Knowledge Translation Process in a Middle Income Country

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

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