Out-of-pocket costs and affordability of upper limb prostheses

Abstract

Background: Given the funding policies in the Department of Veterans Affairs, the affordability of prostheses may be less of a concern among Veterans as compared to civilians. Objectives: Compare rates of out-of-pocket prosthesis-related payments for Veterans and non-Veterans with upper limb amputation (ULA), develop and validate a measure of prosthesis affordability, and evaluate the impact of affordability on prosthesis nonuse. Study design: Telephone survey of 727 persons with ULA; 76% Veterans and 24% non-Veterans. Methods: Odds of paying out-of-pocket costs for Veterans compared with non-Veterans were computed using logistic regression. Cognitive and pilot testing resulted in a new scale, evaluated using confirmatory factor and Rasch analysis. Proportions of respondents who cited affordability as a reason for never using or abandoning a prosthesis were calculated.Results: Twenty percent of those who ever used a prosthesis paid out-of-pocket costs. Veterans had 0.20 odds (95% confidence interval, 0.14-0.30) of paying out-of-pocket costs compared with non-Veterans. Confirmatory factor analysis supported unidimensionality of the 4-item Prosthesis Affordability scale. Rasch person reliability was 0.78. Cronbach alpha was 0.87. Overall, 14% of prosthesis never-users said affordability was a reason for nonuse; 9.6% and 16.5% of former prosthesis users said affordability of repairs or replacement, respectively, was a reason for abandonment. Conclusions: Out-of-pocket prosthesis costs were paid by 20% of those sample, with Veterans less likely to incur costs. The Prosthesis Affordability scale developed in this study was reliable and valid for persons with ULA. Prosthesis affordability was a common reason for never using or abandoning prostheses.

Prosthesis usability experience is associated with extent of upper limb prosthesis adoption: A Structural Equation Modeling (SEM) analysis

“…The survey included demographic questions related to sex, Veteran status, race, and ethnicity. It also included the Trinity Amputee Prosthetic Evaluation Scale (TAPES)-Upper prosthesis satisfaction measure [ 30 ], the Orthotics and Prosthetics User Survey (OPUS), Client Satisfaction with Device (CSD) scale [ 31 ], three new subscales from a revised OPUS CSD (Comfort, Appearance, Utility) [ 32 ] and additional items and measures related to psychosocial adjustment [ 33 ], activity performance [ 34 , 35 ], patient experience [ 36 ], and residual limb health [ 37 ], and prosthesis affordability [ 38 ], all reported elsewhere.…”

Prevalence and Predictors of Unmet Need for Upper-Limb Prostheses: An Observational Cohort Study

“…16,18 A recent study of US veterans and nonveterans with ULA found that 14% of persons who never used a prosthesis and 9.6%-16.5% of prosthesis abandoners reported that affordability was a primary reason for nonuse with veterans having 0.20 the odds of paying outof-pocket costs compared with nonveterans. 19 Unmet need for assistive technologies, including mobility devices, has been widely studied, 2 and scoping reviews on global needs for rehabilitation services and equipment 2 point to unmet need for prostheses, particularly in geographic areas affected by war, where prosthetic expertise and resources are lacking. However, no prior studies have examined the prevalence of unmet prosthesis need among persons with ULA who were not using a prosthesis.…”

“…Others may lack access to prosthetic expertise, which varies across the United States, 3,17 or may abandon or reject prostheses because they are unable to afford the prosthesis and/or the associated costs for repair and maintenance 16,18 . A recent study of US veterans and nonveterans with ULA found that 14% of persons who never used a prosthesis and 9.6%–16.5% of prosthesis abandoners reported that affordability was a primary reason for nonuse with veterans having 0.20 the odds of paying out-of-pocket costs compared with nonveterans 19 …”