Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, San Francisco, CA.
Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA.
Arch Phys Med Rehabil. 2021 Jul;102(7):1404-1415.e2. doi: 10.1016/j.apmr.2021.02.010. Epub 2021 Mar 9.
To synthesize extant literature on the cost-effectiveness of prosthetic interventions and explore applicability to low- and middle-income country (LMIC) settings.
A systematic literature review using subject headings including "prosthetics," "amputation," and "cost analysis" was performed with PubMed, Embase, and Web of Science search engines, yielding 1194 articles. An additional 22 articles were identified via backward citation searching for 1144 total after duplicate removal. The search was last run in May of 2019.
Studies were included if they conducted an economic analysis of an upper or lower extremity prosthetic device. Studies were excluded if (1) full text was unavailable in English; (2) study was a systematic review or meta-analysis; or (3) study did not have a prosthetic comparison group. Using DistillerSR software, 2 authors independently conducted title and abstract screening. One author conducted full-text screening. The proportion of initially identified studies that met final inclusion criteria was 1% (12 of 1144).
Data were dually extracted by 2 authors and reviewed by 3 additional authors.
All included studies (N=12) examined lower extremity amputations comparing advanced technology. No studies were conducted in LMICs. Comparable data between studies demonstrated (1) the cost-effectiveness of microprocessor- over nonmicroprocessor-controlled knees for transfemoral amputation in high-income settings; (2) equivocal findings regarding osseointegrated vs socket-suspended prostheses; and (3) increased cost for ICEX and modular socket systems over patellar tendon-bearing socket systems with no functional improvement.
There are few prosthetic cost analyses in the literature. Additional analyses are needed to determine the direct and indirect costs associated with prosthetic acquisition, fitting, and maintenance; the costs of amputee rehabilitation; and long-term economic and quality-of-life benefits. Such studies may guide future prosthetic and rehabilitative care, especially in resource-austere settings where prosthetic needs are greatest.
综合现有关于假肢干预措施成本效益的文献，并探讨其在中低收入国家（LMIC）环境中的适用性。
使用主题词“假肢”、“截肢”和“成本分析”进行了系统的文献检索，检索了 PubMed、Embase 和 Web of Science 搜索引擎，共得到 1194 篇文章。通过回溯引文搜索，又额外找到了 22 篇文章，共得到 1144 篇文章，去除重复后得到 1144 篇。最后一次搜索是在 2019 年 5 月进行的。
如果研究对上肢或下肢假肢装置进行了经济分析，则将其纳入研究。如果（1）全文无法以英文获取；（2）研究为系统评价或荟萃分析；或（3）研究没有假肢对照组，则将其排除在外。使用 DistillerSR 软件，两位作者独立进行了标题和摘要筛选。一位作者进行了全文筛选。最初确定的符合最终纳入标准的研究比例为 1%（1144 篇中的 12 篇）。
两位作者共同进行了数据提取，并由另外三位作者进行了审查。
所有纳入的研究（N=12）均比较了高级技术的下肢截肢情况。没有在 LMIC 进行的研究。研究之间具有可比性的数据表明：（1）在高收入环境中，对于股骨截肢，微处理器控制膝关节比非微处理器控制膝关节更具成本效益；（2）对于骨整合假肢和套式假肢，结果存在争议；（3）与髌腱承重套式系统相比，ICEX 和模块化套式系统的成本增加，但功能没有改善。
文献中关于假肢的成本分析很少。需要进一步的分析来确定与假肢获得、适配和维护相关的直接和间接成本；与假肢相关的康复费用；以及长期的经济效益和生活质量收益。这些研究可能为未来的假肢和康复护理提供指导，特别是在资源匮乏的环境中，这些环境中对假肢的需求最大。
