Abstract
A preliminary cost-utility analysis (CUA) of prosthetic care innovations can provide timely information during the early stage of product development and clinical usage. Concepts of preliminary CUAs are emerging. However, several obstacles must be overcome before these analyses are performed routinely. Disparities of methods and high uncertainty make the outcomes of usual preliminary CUAs challenging to interpret, appraise and share. These shortcomings create opportunities for a basic framework of preliminary CUAs. First, I introduced a basic framework of a preliminary CUA built around a series of constructs and hands-on recommendations. Then, I appraised this framework considering the strengths and weaknesses, barriers and facilitators, and return on investment. The design of the basic framework was determined through the review of health economic and prosthetic-specific literature. A preliminary CUA comparing the costs and utilities between usual intervention and an innovation could be achieved through a 15-step iterative process focusing on feasibility, constructs, analysis, and interpretation of outcomes. This CUA provides sufficient evidence to identify knowledge gaps and improvement areas, educate about the design of subsequent full CUAs, and obtain fast-track approval from governing bodies. Like previous CUAs, the main limitations were inherent to the constructs (e.g., narrow perspective, plausible scenarios, mid-term time horizon, substantial assumptions, data mismatch, high uncertainty). Key facilitators potentially transferable across preliminary CUAs of prosthetic care innovations included choosing abided constructs, capitalizing on prior schedules of expenses, and benchmarking baseline or incremental utilities. This new approach with preliminary CUA can simplify the selection of methods, standardize outcomes, ease comparisons between innovations, and streamline pathways for adoption. Further collegial efforts toward validating standard preliminary CUAs will facilitate access to economic prosthetic care innovations, improving the lives of individuals suffering from limb loss worldwide.
Highlights
The revolutionary car maker and industrialist Henry Ford (1863-1947) said, “if you think of standardization as the best that you know today, but which is to be improved tomorrow; you get somewhere.” The automobile and healthcare industries might be two worlds apart
Further collegial efforts toward validating standard preliminary cost-utility analysis (CUA) will facilitate access to economic prosthetic care innovations, improving the lives of individuals suffering from limb loss worldwide
This study was an initial effort to standardize a basic framework of preliminary CUA comparing the prosthetic care provisions with and without innovation suitable to improve prosthetic fittings
Summary
The revolutionary car maker and industrialist Henry Ford (1863-1947) said, “if you think of standardization as the best that you know today, but which is to be improved tomorrow; you get somewhere.” The automobile and healthcare industries might be two worlds apart. Multiple pathways and disparity constructs make the outcomes of these CUAs (e.g., costs, utilities, ICURs) challenging to interpret (e.g., comparison between innovations, generalization across healthcare), appraise (e.g., Consolidated Health Economic Evaluation Reporting Standards (CHEERS), Consensus Health Economic Criteria (CHEC) extended checklists) and share (e.g., publication).[3,23,24,25]. Promoters rely on their abilities to make valid assumptions while opting for a specific CUA pathway of innovations.[1] this does not mean that preliminary CUAs of a given innovation must be highly individualized. This step searches for what Ijzerman and Steuten (2011) called “likely safety” including some indications and preferably early evidence of the safety level of the
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