RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA.
RAND Corporation, 1200 South Hayes Street, Arlington, VA, 22202-5050, USA.
J Neuroeng Rehabil. 2018 Sep 5;15(Suppl 1):62. doi: 10.1186/s12984-018-0405-8.
Advanced prosthetic knees allow for more dynamic movements and improved quality of life, but payers have recently started questioning their value. To answer this question, the differential clinical outcomes and cost of microprocessor-controlled knees (MPK) compared to non-microprocessor controlled knees (NMPK) were assessed.
We conducted a literature review of the clinical and economic impacts of prosthetic knees, convened technical expert panel meetings, and implemented a simulation model over a 10-year time period for unilateral transfemoral Medicare amputees with a Medicare Functional Classification Level of 3 and 4 using estimates from the published literature and expert input. The results are summarized as an incremental cost effectiveness ratio (ICER) from a societal perspective, i.e., the incremental cost of MPK compared to NMPK for each quality-adjusted life-year gained. All costs were adjusted to 2016 U.S. dollars and discounted using a 3% rate to the present time.
The results demonstrated that compared to NMPK over a 10-year time period: for every 100 persons, MPK results in 82 fewer major injurious falls, 62 fewer minor injurious falls, 16 fewer incidences of osteoarthritis, and 11 lives saved; on a per person per year basis, MPK reduces direct healthcare cost by $3676 and indirect cost by $909, but increases device acquisition and repair cost by $6287 and total cost by $1702; on a per person basis, MPK is associated with an incremental total cost of $10,604 and increases the number of life years by 0.11 and quality adjusted life years by 0.91. MPK has an ICER ratio of $11,606 per quality adjusted life year, and the economic benefits of MPK are robust in various sensitivity analyses.
Advanced prosthetics for transfemoral amputees, specifically MPKs, are associated with improved clinical benefits compared to non-MPKs. The economic benefits of MPKs are similar to or even greater than those of other medical technologies currently reimbursed by U.S. payers.
先进的假肢膝关节允许更动态的运动和提高生活质量，但支付者最近开始质疑其价值。为了回答这个问题，评估了微处理器控制膝关节（MPK）与非微处理器控制膝关节（NMPK）的临床结果和成本差异。
我们对假肢膝关节的临床和经济影响进行了文献回顾，召开了技术专家小组会议，并在 10 年的时间内使用来自已发表文献和专家意见的估计值，为 Medicare 功能分级 3 和 4 的单侧股骨截肢 Medicare 患者实施了模拟模型。结果以社会视角的增量成本效益比（ICER）进行总结，即与 NMPK 相比，每获得一个质量调整生命年，MPK 的增量成本。所有成本均按 2016 年美元进行调整，并按 3%的贴现率贴现至当前时间。
结果表明，与 NMPK 相比，在 10 年内：每 100 人中，MPK 可减少 82 次重大伤害性跌倒，62 次较小伤害性跌倒，16 次骨关节炎发作和 11 例死亡；按每人每年计算，MPK 可降低直接医疗保健成本 3676 美元，间接成本 909 美元，但增加设备购置和维修成本 6287 美元和总费用 1702 美元；按每人计算，MPK 与增量总成本 10604 美元相关，增加 0.11 个生命年和 0.91 个质量调整生命年。MPK 的 ICER 比率为每质量调整生命年 11606 美元，并且在各种敏感性分析中，MPK 的经济效益都是稳健的。
与非 MPK 相比，股骨截肢患者的高级假肢，特别是 MPK，与改善的临床益处相关。MPK 的经济效益与美国支付者目前报销的其他医疗技术相似甚至更高。
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