Cost effectiveness analysis osseo-integrated protheses for transfemoral amputation.

Research Objectives: Evaluate US costs and effectiveness using a disease state specific quality of life instrument for treatment naïve and refractory patients transfemoral amputees using a socket and osseointegrated prosthesis.

Design: Lifetime Markov models

Setting: Home

Participants: Treatment refractory and treatment naïve healthy and active middle-aged male transfemoral amputees evaluated for costs and quality of life assessment over their lifetime.

Interventions: Evaluation of cost and quality of life for socket and osseointegrated prosthesis in a decision tree Markov model.

Main Outcome Measures: Lifetime cost of direct medical care; lifetime quality of life as measured by Q-TFA (quality of life transfemoral amputee)

Results: For treatment naïve patients and treatment refractory the ICERs were as follows over various timeframes (TAbel 1):

Table 1: Incremental cost effectiveness analysis
Disease state Timeframe (years) Costs QALYs Cost/QALY ICER
Treatment naïve socket 20 $152,668 901 $169
Treatment naïve OPRA 20 $234,845 1,125 $209 $367
Treatment naïve socket 30 $184,650 1,175 $157
Treatment naïve OPRA 30 $268,676 1,470 $183 $285
Treatment naïve socket 42 $212,420 1,413 $150
Treatment naïve OPRA 42 $298,051 1,770 $168 $240
Treatment refractory socket 20 $77,553 784 $99
Treatment refractory OPRA 20 $234,845 1,125 $209 $461
Treatment refractory socket 30 $102,146 1,033 $99
Treatment refractory OPRA 30 $268,676 1,470 $183 $381
Treatment refractory socket 42 $123,518 1250 $99
Treatment refractory OPRA 42 $298,051 1,770 $168 $367

In sensitivity analysis, related to variable thresholds that would affect a change in the course of treatment based on cost alone the following were found to do so in the treatment naïve group: Yearly replacement components of >$7,857 (socket) and; Initial cost of OPRA prosthesis <$14,894. For treatment refractory patients, the threshold was >$14,407.

Conclusions: The use of the OPRA prostheses provides a cost-effective alternative to a socket prosthesis when evaluated with a disease specific health instrument. The use of the OPRA prosthesis should be considered both in treatment naïve and treatment refractory socket prosthesis patients.

Author(s) Disclosures: JV is a cost effectiveness expert working with Integrum.