Efanov J I, Tchiloemba B, Izadpanah A, Harris P G, Danino M A
Plastic and Reconstructive Surgery Service, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
JPRAS Open. 2022 Mar 19;32:150-160. doi: 10.1016/j.jpra.2022.03.003. eCollection 2022 Jun.
Hand vascularized composite allotransplantation (VCA) and myoelectric prostheses have proven their efficacy for treating hand amputation. Despite reported functional outcomes, the lack of consensus on VCA versus myoelectric prostheses brought us to report on their utilities and costs within the Canadian healthcare system.
A review of utility outcomes and costs was performed for VCA and myoelectric prostheses and a comparison between unilateral versus bilateral amputations was made.
The simulation model demonstrated that significant savings could be achieved with both hand transplantation ($10.04 billion) and myoelectric prostheses ($12.17 billion) in all Canadian patients sustaining hand amputation with a 30-year life expectancy., Myoelectric prosthesis had lowest total cost compared to hand VCA by generating savings of $4,458,445,840 and $1,868,121,840 when compared to bilateral and unilateral upper limb amputations respectively.
Treatment of unilateral amputations with myoelectric prostheses would cost significantly less to the society, whereas the gap in cost savings becomes less significant in bilateral amputees. From the socioeconomic standpoint of the Canadian healthcare system, this simulation model demonstrates that significant savings can be achieved with both treatments.
手部血管化复合组织异体移植（VCA）和肌电假肢已证明其在治疗手部截肢方面的有效性。尽管有报道称两者有功能结局，但对于VCA与肌电假肢缺乏共识，这促使我们报告它们在加拿大医疗保健系统中的效用和成本。
对VCA和肌电假肢的效用结果和成本进行了综述，并对单侧与双侧截肢进行了比较。
模拟模型表明，在所有预期寿命为30年的加拿大手部截肢患者中，手部移植（100.4亿美元）和肌电假肢（121.7亿美元）均可实现显著的成本节省。与手部VCA相比，肌电假肢的总成本最低，与双侧和单侧上肢截肢相比，分别节省44.5844584亿美元和18和18.6812184亿美元。
用肌电假肢治疗单侧截肢对社会的成本要低得多，而在双侧截肢患者中，成本节省的差距则不那么显著。从加拿大医疗保健系统的社会经济角度来看，该模拟模型表明，这两种治疗方法均可实现显著的成本节省。
