Provision of bone-anchored prostheses using osseointegrated implant: Leading role of Queensland Artificial Limb Service

Background Direct skeletal attachment is gradually accepted as an alternative to socket-suspended prostheses typically used to wear artificial limbs.[1-10] Indeed, the number of patients undergoing surgical implantation of osseointegrated fixation enabling fitting of bone-anchored prostheses is on the rise at an unprecedented pace, particularly in Australia and Queensland.[11-15] Studies showed the biomechanical advantages and clinical benefits of the treatment while highlighting that some adverse events are yet to be fully resolved.[16-26] However, less understood are the health economic benefits. Queensland Artificial Limb Service (QALS) produced a series of leading publications focusing on health services and economic evaluations of the treatment.[11, 27-33] This presentation will particularly focus on the latest cost-effectiveness analyses of provision of transfemoral and transtibial bone-anchored prostheses.[14, 34] Methods A total of 22 participants including 16 with transfemoral and 6 with transtibial fitted with bone-anchored prostheses were included in this study. All participants were registered consumers solely supported by QALS. Actual costs were extracted from financial records and completed by typical costs when needed.[15] Health gains corresponding to quality-adjusted life-year (QALY) were estimated using utility data extracted from the literature.[35, 36] The economical advantage of provision of bone-anchored prostheses over socket-suspended prostheses was determined using incremental cost-effectiveness ratio (ICER) over six-year time horizon.[14, 34] Results The indicative ICERs for provision of transfemoral and transtibial bone-anchored prostheses were approximately $17,000 and $11,400 per QALY, respectively. This study confirmed that provision of both transfemoral and transtibial bone-anchored prostheses might be a reasonable alternative to socket-suspended prostheses at least from a prosthetic care perspective in Australian context. Conclusion Altogether, these initial evidenced-based economic evaluations provided a working approach for decision makers responsible for policies around the prosthetic care of individuals with lower limb amputation worldwide