What are Estimated Reimbursements for Lower Extremity Prostheses Capable of Surgical and Nonsurgical Lengthening?

Abstract

Background Growing prostheses accommodate skeletally immature patients with bone tumors undergoing limbpreserving surgery. Early devices required surgical procedures for lengthening; recent devices lengthen without surgery. Expenses for newer expandable devices that lengthen without surgery are more than for their predecessors but overall reimbursement amounts are not known.Questions/purposes We sought to determine reimbursement amounts associated with lengthening of growing prostheses requiring surgical and nonsurgical lengthening. Methods We retrospectively reviewed 17 patients with growing prostheses requiring surgical expansion and eight patients with prostheses capable of nonsurgical expansion. Insurance documents were reviewed to determine the reimbursement for implantation, lengthening, and complications. Growth data were obtained from the literature. Results Mean reimbursement amounts of surgical and nonsurgical lengthenings were $9950 and $272, respectively. Estimated reimbursements associated with implantation of a growing prosthesis varied depending on age, sex, and location. The largest difference was found for 4-year-old boys with distal femoral replacement where reimbursement for expansion to maturity for surgical and nonsurgical lengthening prostheses would be $379,000 and $208,000, respectively. For children requiring more than one surgical expansion, net reimbursements were lower when a noninvasive lengthening device was used. Annual per-prosthesis maintenance reimbursements to address complications for surgical and nonsurgical lengthening prostheses were $3386 and $1856, respectively.

Limb Salvage Using Non‐hinged Endoprosthesis and Staged Correction of Leg‐length Discrepancy for Children with Distal Femoral Malignant Tumors

“…A high complication rate of the extendable prosthesis has been highlighted in some studies. An average 50% revision rate is reported for non‐invasive expandable endoprostheses.…”

“…Besides the high complication rate, 8%–50% of patients who receive an extendible prosthesis do not undergo a lengthening procedure due to tumor relapse. The cost of non‐invasive expandable endoprostheses has been reported to be as high as US$379 000 in 4‐year‐old patients. Considering complication rates and the high cost of an extendible endoprosthesis, some authors advocate temporary hemiarthroplasty and staged lengthening, with advantages including the simple technique and the low cost.…”

The impact of cost on quality of surgical management in non-metastatic extremity sarcoma: A cross-country narrative literature review with a systematic approach

“…They have also formed the basis for more recent cost analyses. 26,35,47 According to Grimer's estimates, annual maintenance costs would be $17,073-35,475 for the provision and maintenance of a lower limb prosthesis following amputation in the UK. 24 Barr et al questioned whether perpetual maintenance costs were universally applicable, describing them as "an assumption evidently subject to argument".…”

Wachstumsprothesen nach Sarkomresektionen im Kindes- und Jugendalter

“…Mit der Kostenanalyse beschäftigt sich schließlich die Arbeit von Henderson et al und vergleicht 17 Patienten, die mit einer minimal-invasiv verlängerbaren Prothese und 8 Patienten, die mit einer nichtinvasiv verlängerbaren Prothese versorgt wurden [13]. Unter Zugrundelegung US-amerikanischer Verhältnisse schließen die Autoren, dass nichtinvasiv verlängerbare Prothesen trotz höherer Initialkosten aufgrund fehlender Verlängerungseingriffe günstiger abschneiden als minimal-invasiv verlängerbare Prothesen.…”