The prevalence of lower limb loss in children and associated costs of prosthetic devices: A national study of commercial insurance claims

Abstract

Background: Although the incidence of major pediatric lower limb loss secondary to either congenital deficiencies or acquired amputations is relatively low, the prevalence of lower limb loss among children in the United States (US) remains unknown. Objectives: To estimate the prevalence of major lower limb loss, and the associated prosthetic services use and costs among commercially-insured children in the US. Study design: Observational, retrospective, longitudinal cohort study. Methods: The IBM MarketScan® Commercial Database was used to identify children (<18 years) with major lower limb loss in the US between 2009 and 2015. Descriptive statistics were used to characterize pediatric cases according to sociodemographic and limb loss characteristics. Multivariate models assessed factors associated with annual prosthetic visits, prosthetic-related costs, and overall medical costs. Results: Of the 36.5 million children in the MarketScan database, 14,038 had a major lower limb loss, yielding a prevalence estimate of 38.5 cases per 100,000 commercially insured children in the US during the 7-year study period. Congenital deficiencies accounted for 84% of cases, followed by 13.5% from trauma. Only 10.1% had at least one prosthesis-related visit during any 12-month period following their cohort entry. Among those, the mean annual prosthetic-related costs ranged from $50 to $29,112 with a median annual cost of $2778 (interquartile range = $4567). Annual coinsurance and copays for prosthetic services accounted for nearly half of the overall annual out-of-pocket outlays with medical care for these children. Conclusion: Pediatric lower limb loss results in lifelong prosthetic needs. This study informs insurers and policy-makers regarding the prevalence of these patients and the medical costs for their care.

Demographic and clinical characteristics of children with limb loss in Saudi Arabia: A retrospective study

“…However, literature shows that unilateral upper limb deficiency is the most common congenital limb loss. 7,[9][10][11] Epidemiological studies investigating acquired limb loss in the pediatric population shows that trauma is the most common cause of limb loss. [11][12][13] Similar to congenital limb loss, the prevalence of acquired limb loss differs widely in literature, given the methodological differences in studies.…”

“…7,[9][10][11] Epidemiological studies investigating acquired limb loss in the pediatric population shows that trauma is the most common cause of limb loss. [11][12][13] Similar to congenital limb loss, the prevalence of acquired limb loss differs widely in literature, given the methodological differences in studies. McDonald et al 12 estimated the global prevalence of traumatic limb amputation based on the "Global Burden of Disease Study 2017" and found that 57.7 million people were living with limb amputation due to traumatic causes worldwide.…”

“…[15][16][17] The mechanism of injury leading to traumatic limb loss varies in literature; however, lawnmower accidents, door crush injuries, and road traffic injuries were commonly reported mechanisms. 11,[14][15][16]18 Evidence of limb loss in the pediatric population in Saudi Arabia is limited. A 14-year retrospective study (1977)(1978)(1979)(1980)(1981)(1982)(1983)(1984)(1985)(1986)(1987)(1988)(1989)(1990) revealed that trauma-related amputations accounted for approximately 60% of limb loss in the sample, whereas congenital-related amputations accounted for only 4.7%.…”

“…However, literature shows that unilateral upper limb deficiency is the most common congenital limb loss. 7,9-11…”

Innovations in Pediatric Prosthetics

“…They found a prevalence of 38.5 cases per 100,000 per year between 2009-2015. 2 Congenital limb absence or difference accounted for 84% of the cases, followed by trauma at 13.5%. 2 Although this diagnosis may initially be devastating to the family, with care from the multidisciplinary medical team, these children tend to do well.…”