Cost-effectiveness of transtibial bone-anchored prostheses using osseointegrated fixation: From challenges to preliminary data

Introduction. This initial cost-effectiveness evaluation compared the provision of transtibial bone-anchored prostheses (TTA-BAP) with socket-suspended prostheses (TTA-SSP) over a six-year time horizon from a governmental prosthetic care perspective. The purposes were to present ways we dealt with barriers encountered during the cost-effectiveness analysis. The objectives were to detail the extraction of baseline and incremental costs and utilities required to provide preliminary incremental cost effectiveness ratios (ICERs) per quality-adjusted life-year (QALY). Materials and Methods. This retrospective case-series study involved six participants fitted consecutively with TTA-SSP and TTA-BAP. Total costs combined actual and typical costs extracted from financial records and a schedule of allowable expenses, respectively. Baseline utilities were extracted from the literature while incremental utilities were assumed. Results. ICERs ranged between -$25,065 and $41,929 per QALY. Indicative ICER was approximately $11,400 per QALY. Provision of TTA-BAP was cost-effective and cost-saving for 83% and 33% of cases, respectively. Discussion. Educated choices were required to overcome unavailability of individual costs (e.g., creation of schedule of allowable expenses, blending of actual and typical costs) and utilities (e.g., extraction of baseline from literature, assumptions for incremental gain). Indicative ICER might lead to adoption of TTA-BAP, at least from an Australian governmental prosthetic care perspective