A research team conducted the first cost-benefit analysis of osseointegrated implant (OI) prostheses compared to socket-suspended prostheses for lower-limb amputees in the United States. The researchers concluded that OI prostheses provide a higher quality of life at affordable costs when compared to poorly tolerated socket-suspended prostheses. They also found that cost-effectiveness is largely determined by the patient’s previous socket-suspended prosthesis costs and is limited by the frequency and costs of OI mechanical failure.
Twenty-five patients (12 female) were included in the retrospective chart review. The mean follow-up was 17 months post-implantation.
Costs were calculated in a bottom-up approach using Current Procedural Terminology codes. Utilities and socket-suspended prosthesis costs were derived from previous studies. A Monte Carlo model was used to project costs and lifetime quality-adjusted life years for OI and socket-suspended prostheses, and the incremental cost-effectiveness ratio (ICER) of OI compared to socket-suspended prostheses was determined.
The average cost of OI surgery was $54,463. Twenty percent of patients required pre-implantation soft tissue revision surgery ($49,191). Complication rates per year and average costs were as follows: soft tissue infection (29 percent, $435), bone/implant infection (11 percent, $11,721), neuroma development (14 percent, $14,659), and mechanical failure (17 percent, $46,513). The ICER was $44,660.
A cost-effectiveness acceptability curve demonstrated that OI was favored over socket-suspended prostheses in 78 percent of cases at a willingness-to-pay of $100,000 per quality-adjusted life year. In a one-way sensitivity analysis, the ICER was most sensitive to the mechanical failure rate, mechanical failure cost, and prior socket-suspended prosthesis costs.
The study, “A Cost-Benefit Analysis of Osseointegrated Prostheses for Lower Limb Amputees in the US Health Care System,” was published in Annals of Plastic Surgery.
