Abstract
ABSTRACT Background Advanced prosthetic knees allow for more dynamic movements and improved quality of life, but payers have recently started questioning their value. To answer this question, the differential clinical outcomes and cost of microprocessor-controlled knees (MPK) compared to non-microprocessor controlled knees (NMPK) were assessed. Methods We conducted a literature review of the clinical and economic impacts of prosthetic knees, convened technical expert panel meetings, and implemented a simulation model over a 10-year time period for unilateral transfemoral Medicare amputees with a Medicare Functional Classification Level of 3 and 4 using estimates from the published literature and expert input. The results are summarized as an incremental cost effectiveness ratio (ICER) from a societal perspective, i.e., the incremental cost of MPK compared to NMPK for each quality-adjusted life-year gained. All costs were adjusted to 2016 U.S. dollars and discounted using a 3 percent rate to the present time. Results The results demonstrated that compared to NMPK over a 10-year time period: for every 100 persons, MPK results in 82 fewer major injurious falls, 62 fewer minor injurious falls, 16 fewer incidences of osteoarthritis, and 11 lives saved; on a per person per year basis, MPK reduces direct healthcare cost by $3,676 and indirect cost by $909, but increases device acquisition and repair cost by $6,287 and total cost by $1,702; on a per person basis, MPK is associated with an incremental total cost of $10,604 and increases the number of life years by 0.11 and quality adjusted life years by 0.91. MPK has an ICER ratio of $11,606 per quality adjusted life year, and the economic benefits of MPK are robust in various sensitivity analyses. Conclusions Advanced prosthetics for transfemoral amputees, specifically MPKs, are associated with improved clinical benefits compared to non-MPKs. The economic benefits of MPKs are similar to or even greater than those of other medical technologies currently reimbursed by U.S. payers.
Highlights
For every 100 people, microprocessor-controlled knees (MPKs) result in 16 fewer incidences of osteoarthritis on a per-person-per-year basis, MPKs reduce direct health care costs by $3,676 and indirect costs by $909, but increase device acquisition and repair costs by $6,287 and total costs by $1,702 on a per-person basis, MPKs are associated with an incremental total cost of $10,604 on a per-person basis, MPKs increase the number of life years by 0.11 and qualityadjusted life years by 0.91 MPKs have an incremental cost-effectiveness ratio (ICER) of $11,606 per quality-adjusted life year the economic benefits of MPKs are robust in various sensitivity analyses
The results are summarized as an incremental cost-effectiveness ratio (ICER) from a societal perspective, i.e., the incremental cost of MPKs compared with NMPKs for each quality-adjusted life year gained
We found that compared with NMPKs, MPKs are associated with substantial improvement in physical function and reductions in incidences of falls and osteoarthritis
Summary
It is estimated that about 1.9 million individuals in the United States are living with the loss of a limb. Due to recent advances in technology, prosthetic knees and feet allow for more-dynamic movements and improved quality of life, but payers have recently started questioning their value for money. To answer this question, we developed a simulation model to assess the differential clinical outcomes and costs of microprocessor-controlled knees (MPKs) compared with non-MPKs (NMPKs). The results are summarized as an incremental cost-effectiveness ratio (ICER) from a societal perspective, i.e., the incremental cost of MPKs compared with NMPKs for each quality-adjusted life year gained. The economic benefits of MPKs are similar to or even greater than those of other medical technologies currently reimbursed by U.S payers
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