Trends and Opportunities in Health Economic Evaluations of Prosthetic Care Innovations

Abstract

Overcoming obstacles to prosthetic fittings requires frequent tryouts of sockets and components. Repetitions of interventions are upsetting for users and place substantial economic burden on healthcare systems. Encouraging prosthetic care innovations capable of alleviating clinical and financial shortcomings of socket-based solutions is essential. Nonetheless, evidence of socio-economic benefits of an innovation are required to facilitate access to markets. Unfortunately, complex decisions must be made when allocating resources toward the most relevant health economic evaluation (HEE) at a given stage of development of an innovation. This paper first, aimed to show the importance and challenges of HEEs of intervention facilitating prosthetic fittings. Next, the main trends in HEEs at various phases of product development and clinical acceptance of prosthetic care innovations were outlined. Then, opportunities for a basic framework of a preliminary cost-utility analysis (CUA) during the mid-stage of development of prosthetic care innovations were highlighted. To do this, fundamental and applied health economic literature and prosthetic-specific publications were reviewed to extract and analyse the trends in HEEs of new medical and prosthetic technologies, respectively. The findings show there is consensus around the weaknesses of full CUAs (e.g., lack of timeliness, resource-intensive) and strengths of preliminary CUAs (e.g., identify evidence gaps, educate design of full CUA, fast-track approval). However, several obstacles must be overcome before preliminary CUA of prosthetic care innovations will be routinely carried out. Disparities of methods and constructs of usual preliminary CUA are barriers that could be alleviated by a more standardized framework. The paper concludes by identifying that there are opportunities for the development of a basic framework of preliminary CUA of prosthetic care innovations. Ultimately, the collaborative design of a framework could simplify selection of the methods, standardise outcomes, ease comparisons between innovations and streamline pathways for adoption. This might facilitate access to economical solutions that could improve the life of individuals suffering from limb loss. 
 Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/36364/28327
 How To Cite: Frossard L. Trends and opportunities in health economic evaluations of prosthetic care innovations. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, No.9. https://doi.org/10.33137/cpoj.v4i2.36364
 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 Preliminary Cost-Utility Analysis of the Prosthetic Care Innovations: Basic Framework

“…Ultimately, this step reveals the unique value additions of the innovation compared to other interventions that could alleviate the current shortcomings of prosthetic fittings. 3,[26][27][28][29][30][31] Some obvious facilitators include the literature review and engagements with suppliers and clinicians to access guidelines and expert opinions. Evidence of efficacy might be easier to find because manufacturers tend to assess the benefits of innovations before the harms.…”

“…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.…”

“…[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. Promoters could rely on strong recommendations that might be provided after a wide clinical adoption.…”

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Economic evaluations of prosthetic care innovationsPromoters of prosthetic care interventions, including endusers, providers of prosthetic solutions, and administrators of healthcare organizations, are increasingly motivated to demonstrate the socio-economic benefits of their innovations. [1][2][3]

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

“…More importantly, these publications were considered and often cited in recent health technology assessments of osseointegrated prosthetic solutions produced by several government organizations (e.g., Australian states, Canadian provinces, United Kingdom, New Zealand, Spain). [34][35][36][37][38][39][40] This work provided guidance when the Australian National Disability Insurance Scheme developed its funding model.…”