HEALTH SERVICE DELIVERY AND ECONOMIC EVALUATION OF LIMB LOWER BONE-ANCHORED PROSTHESES: A SUMMARY OF THE QUEENSLAND ARTIFICIAL LIMB SERVICE’S EXPERIENCE
Open Access
- 21 September 2021
- journal article
- Published by University of Toronto Libraries - UOTL in CANADIAN PROSTHETICS & ORTHOTICS JOURNAL
- Vol. 4 (2)
- https://doi.org/10.33137/cpoj.v4i2.36210
Abstract
The emergence of skeletal prosthetic attachments leaves governmental organizations facing the challenge of implementing equitable policies that support the provision of bone-anchored prostheses (BAPs). In 2013, the Queensland Artificial Limb Service (QALS) started a five-year research project focusing on health service delivery and economic evaluation of BAPs. This paper reflects on the QALS experience, particularly the lessons learned. QALS’ jurisdiction and drivers are presented first, followed by the impact of outcomes, barriers, and facilitators, as well as future developments of this work. The 21 publications produced during this project (e.g., reimbursement policy, role of prosthetists, continuous improvement procedure, quality of life, preliminary cost-utilities) were summarized. Literature on past, current, and upcoming developments of BAP was reviewed to discuss the practical implications of this work. A primary outcome of this project was a policy developed by QALS supporting up to 22 h of labor for the provision of BAP care. The indicative incremental cost-utility ratio for transfemoral and transtibial BAPs was approximately AUD$17,000 and AUD$12,000, respectively, per quality-adjusted life-year compared to socket prostheses. This project was challenged by 17 barriers (e.g., limited resources, inconsistency of care pathways, design of preliminary cost-utility analyses) but eased by 18 facilitators (e.g., action research plan, customized database, use of free repositories). In conclusion, we concluded that lower limb BAP might be an acceptable alternative to socket prostheses from an Australian government prosthetic care perspective. Hopefully, this work will inform promoters of prosthetic innovations committed to making bionic solutions widely accessible to a growing population of individuals suffering from limb loss worldwide. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/36210/28330 How To Cite: Berg D, Frossard L. Health service delivery and economic evaluation of limb lower bone-anchored prostheses: A summary of the Queensland artificial limb service’s experience. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, No.12. https://doi.org/10.33137/cpoj.v4i2.36210 Corresponding Author: Laurent Frossard, PhD, Professor of Bionics YourResearchProject Pty Ltd, Brisbane, Australia. E-Mail: laurentfrossard@outlook.com ORCID number: https://orcid.org/0000-0002-0248-9589Keywords
This publication has 75 references indexed in Scilit:
- Load applied on bone-anchored transfemoral prosthesis: Characterization of a prosthesis A pilot studyJournal of Rehabilitation Research and Development, 2013
- Stable fixation of an osseointegated implant system for above-the-knee amputeesActa Orthopaedica, 2012
- Introduction and uptake of new medical technologies in the Australian health care system: A qualitative studyHealth Policy, 2011
- Osseointegrated Titanium Implants for Limb Prostheses Attachments: Infectious ComplicationsClinical Orthopaedics and Related Research, 2010
- Apparatus for monitoring load bearing rehabilitation exercises of a transfemoral amputee fitted with an osseointegrated fixation: A proof-of-concept studyGait & Posture, 2010
- FE stress analysis of the interface between the bone and an osseointegrated implant for amputees – Implications to refine the rehabilitation programClinical Biomechanics, 2008
- Interpreting the Results of Cost-Effectiveness StudiesJournal of the American College of Cardiology, 2008
- Cost-Effectiveness of C-Leg Compared With Non–Microprocessor-Controlled Knees: A Modeling ApproachArchives of Physical Medicine and Rehabilitation, 2008
- The Development of Coverage Policy for Lower Extremity Prosthetics: The Influence of the Payer on Prosthetic PrescriptionJPO Journal of Prosthetics and Orthotics, 2006
- Markov Models in Medical Decision MakingMedical Decision Making, 1993