Economic evaluation of upper limb prostheses in the Netherlands including the cost-effectiveness of multi-grip versus standard myoelectric hand prostheses
Disability and Rehabilitation(2023)
Abstract
PurposeTo investigate the costs, quality of life, and user experiences associated with upper limb prosthesis use, and to evaluate the cost-effectiveness of multi-grip compared to standard myoelectric hand prostheses (MHPs/SHPs).Materials and methodsThe EQ-5D-5L to assess the quality of life, the patient-reported outcome measure to assess the preferred usage features of upper limb prosthesis (PUF-ULP), and a cost questionnaire (societal perspective) were completed by 242 prosthesis users (57% men; mean age = 58 years). Incremental cost-utility and cost-effectiveness ratios (ICUR/ICER) with respectively the EQ-5D-5L and PUF-ULP were calculated to compare MHPs with SHPs. Statistical uncertainty was estimated using bootstrapping. Netherlands Trial Registry number: NL7682.ResultsThe mean yearly total costs related to prosthesis use of MHPs (euro54 112) and SHPs (euro23 501) were higher compared to prostheses with tools/accessories (euro11 977), body-powered (euro11 298), and cosmetic/passive prostheses (euro10 132). EQ-5D-5L and PUF-ULP scores did not differ between prosthesis types. ICUR was euro-728 833 per quality-adjusted life year; ICER was euro-187 798 per PUF-ULP point gained.ConclusionsMyoelectric prostheses, especially MHPs, were most expensive compared to other prostheses, while no differences in quality of life and user experiences were apparent. MHPs were not cost-effective compared to SHPs. When prescribing MHPs, careful consideration of advantages over SHPs is recommended.
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Key words
Upper extremity,prostheses,amputation,artificial limbs,questionnaire,costs and cost analysis,quality of life,patient reported outcome measures
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