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Lifetime cost-effectiveness analysis osseointegrated transfemoral versus socket prosthesis using Markov modelling.

Jeffrey D Voigt1, Benjamin K Potter1,2, Jason Souza3

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The osseointegrated prosthesis (OPRA) is a cost-effective option for transfemoral amputees, offering improved quality of life. This study confirms its value for both new and existing prosthesis users.

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Area of Science:

  • Orthopedic prosthetics
  • Health economics
  • Rehabilitation medicine

Background:

  • Previous cost-effectiveness studies on osseointegrated prostheses (OPRA) used generic quality of life measures and focused on patients who failed socket prostheses.
  • These analyses may not accurately reflect disease-specific quality of life for transfemoral amputees.

Purpose of the Study:

  • To evaluate the cost-effectiveness of the OPRA prosthesis using a disease-specific quality of life instrument.
  • To include both treatment-naïve and socket-refractory transfemoral amputees in the analysis.

Main Methods:

  • Lifetime Markov models were developed for active, middle-aged male transfemoral amputees.
  • Costs included prostheses, complications, and annual maintenance for both socket and OPRA prostheses.
  • Effectiveness was measured using the Questionnaire for Persons with a Transfemoral Amputation (Q-TFA), with a 3% annual discount rate.

Main Results:

  • The lifetime incremental cost-effectiveness ratio (ICER) for OPRA was $279/QALY for treatment-naïve patients and $273/QALY for treatment-refractory patients.
  • Sensitivity analyses identified cost thresholds for switching between socket and OPRA prostheses.

Conclusions:

  • The OPRA prosthesis is a cost-effective alternative for both treatment-naïve and treatment-refractory transfemoral amputees.
  • Disease-specific quality of life assessments, like Q-TFA, are more sensitive for cost-effectiveness evaluations in this population.