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

Abstract

The emergence of skeletal prosthetic attachments leaves governmental organizations facing the challenge of implementing equitable policies that support the provision of bone-anchored prostheses (BAPs). In 2013, the Queensland Artificial Limb Service (QALS) started a five-year research project focusing on health service delivery and economic evaluation of BAPs. This paper reflects on the QALS experience, particularly the lessons learned. QALS’ jurisdiction and drivers are presented first, followed by the impact of outcomes, barriers, and facilitators, as well as future developments of this work. The 21 publications produced during this project (e.g., reimbursement policy, role of prosthetists, continuous improvement procedure, quality of life, preliminary cost-utilities) were summarized. Literature on past, current, and upcoming developments of BAP was reviewed to discuss the practical implications of this work. A primary outcome of this project was a policy developed by QALS supporting up to 22 h of labor for the provision of BAP care. The indicative incremental cost-utility ratio for transfemoral and transtibial BAPs was approximately AUD$17,000 and AUD$12,000, respectively, per quality-adjusted life-year compared to socket prostheses. This project was challenged by 17 barriers (e.g., limited resources, inconsistency of care pathways, design of preliminary cost-utility analyses) but eased by 18 facilitators (e.g., action research plan, customized database, use of free repositories). In conclusion, we concluded that lower limb BAP might be an acceptable alternative to socket prostheses from an Australian government prosthetic care perspective. Hopefully, this work will inform promoters of prosthetic innovations committed to making bionic solutions widely accessible to a growing population of individuals suffering from limb loss worldwide.
 Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/36210/28330
 How To Cite: Berg D, Frossard L. Health service delivery and economic evaluation of limb lower bone-anchored prostheses: A summary of the Queensland artificial limb service’s experience. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, No.12. https://doi.org/10.33137/cpoj.v4i2.36210
 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

A scoring system to evaluate stability of percutaneous osseointegrated implants for transfemoral amputation with validation in the ITAP clinical trial

“…11,12 Central to interface and component adverse events are the challenges on POI stability (interface integration and long term bone fixation success) brought about by factors such as asymmetric loading, implant design and surgical choice (such as alignment and fixation). 13 An evaluation method built around POI stability will provide insight to interface integration and long term bone fixation success. This could influence clinical guidelines for monitoring rehabilitation progress as well as engineering design and surgical fixation choices.…”

“…Currently there is no non-invasive interface monitoring standard which is critical in the evaluation of POI clinical outcome(s). 13 Several monitoring methods have been proposed: Radiological methods include transverse plane cortical thickness by zoning radiographs of implant stems (like the Gruen zoning of hip stems) and tracking changes over time. 25,26 Others have measured periprosthetic bone density using bone turnover markers.…”