Health economic evaluation of microprocessor and non-microprocessor controlled prosthetic knees

Area of Science:

• Prosthetics and Orthotics
• Health Economics
• Rehabilitation Engineering

Background:

• Microprocessor-controlled knees (MPKs) may enhance walking ability and user satisfaction compared to non-microprocessor-controlled knees (NMPKs).
• The higher acquisition cost of MPKs raises questions about their cost-effectiveness relative to NMPKs.

Purpose of the Study:

• To conduct a cost-utility and cost-effectiveness analysis of MPKs versus NMPKs.
• To evaluate these prosthetic options from a societal perspective within the Netherlands.

Main Methods:

• Utilized the EuroQol five dimensions five levels (EQ-5D-5L) for health-related quality of life.
• Employed the Prosthesis Evaluation Questionnaire (PEQ) for prosthesis-specific quality of life.
• Calculated Incremental Cost-Utility Ratio (ICUR) and Incremental Cost-Effectiveness Ratio (ICER), comparing ICUR to the Dutch willingness-to-pay threshold.

Main Results:

• MPK use resulted in a mean increase of 0.032 Quality Adjusted Life Years (QALYs) at an additional cost of €14,626.
• The mean ICUR was €457,063 per QALY gained, significantly exceeding willingness-to-pay thresholds.
• Cost differences were primarily driven by acquisition costs, though partially offset by reduced work absence and healthcare utilization.

Conclusions:

• MPKs demonstrate potential for improved prosthesis-specific quality of life but incur substantial additional costs.
• Short-term improvements in health-related quality of life were insufficient to offset MPK costs.
• The high ICUR suggests MPKs are not cost-effective within the Dutch healthcare system's established thresholds based on this 6-month evaluation.