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

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.