Abstract
BackgroundAdvanced 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.MethodsWe 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% rate to the present time.ResultsThe 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 $3676 and indirect cost by $909, but increases device acquisition and repair cost by $6287 and total cost by $1702; 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.ConclusionsAdvanced 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
Advanced prosthetic knees allow for more dynamic movements and improved quality of life, but payers have recently started questioning their value
The clinical and economic benefits of microprocessor-controlled prosthetic knees (MPK) were compared with those of non-microprocessor controlled prosthetic knees (NMPKs) from a societal perspective, and the results are summarized as an incremental cost-effectiveness ratio (ICER) — a commonly accepted measure for cost-effectiveness or value for money
Target population The analysis focuses on the Medicare population, which includes a diversely aged patient group, because Centers for Medicare and Medicaid Services (CMS) represents the largest payer for prosthetic devices in the country and sets the market standard for reimbursement levels against which commercial payers and the Department of Veterans Affairs often benchmark
Summary
Advanced prosthetic knees allow for more dynamic movements and improved quality of life, but payers have recently started questioning their value. Approximately 1.9 million individuals are living with limb loss according to the Centers for Disease Control and Prevention [2], a figure expected to rise to 3.6 million by 2050 [1] Of this number, it is estimated that 18.5 to 21.0% are transfemoral amputees [3, 4]. Major technological advancements such as microprocessors, and their associated load and position sensors have catalyzed the modernization of prosthetics [11] Such advanced prosthetic knees and feet were developed to allow for safer movements across a range of walking environments and improving user quality of life [11,12,13]
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