Projected Health Care Associated Costs of Workplace-Related Traumatic Amputation After 10, 15, and 20 Years: Part I: Lower Limb

Abstract

ABSTRACT Introduction Previous research has determined the impact of different types of lower-limb prostheses on functional and biomechanical outcomes. Little work, however, has examined the effect of amputation and prostheses on health care costs. The purpose of this investigation was to estimate long-term health care associated costs in individuals with lower-limb amputation of varying limb loss level. Materials and Methods An insurance claims database was obtained via a public records request from the Ohio Bureau of Workers’ Compensation for 361 persons who experienced a traumatic injury in the workplace that resulted in lower-limb amputation. Insurance claims included costs associated with prosthetic limbs and equipment, general hospital care, physical therapy, vocational therapy, prescription medication, and additional health care categories. The population was categorized into two limb loss levels: persons with unilateral transtibial amputation and persons with transfemoral amputation. Prosthetic insurance claim codes were examined to determine and classify the type of prostheses prescribed, based on Medicare guidelines for activity levels (K1–K4), to estimate yearly health care costs associated with each type of prosthesis. These data were used to construct Markov decision models to estimate the expected distribution of long-term (10, 15, and 20 years) health care costs after receiving a prosthesis associated with transtibial and transfemoral amputation. Results Sixty-two persons with transfemoral amputation and 108 persons with transtibial amputation met our inclusion/exclusion criteria. Average time between prosthesis prescriptions varied based on activity and limb loss levels, and on average, individuals with transtibial amputation received a new prosthesis every 1.3 ± 1.6 years and individuals with transfemoral amputation every 2.3 ± 1.8 years. Annual costs associated with activity and limb loss levels varied greatly over time, ranging from $3,000 to $150,000 per patient. Projected health care associated costs totaled $546,067 ± $293,411 and $253,766 ± $142,206 over 20 years for transfemoral and transtibial amputations, respectively. Conclusions The results of this cost investigation provide new information regarding all aspects of health care for individuals with lower-limb amputation, including trends in prosthesis prescription and yearly costs, and how prosthetic prescription may alter these long-term costs.