RESUMO
Several obstacles must be overcome before preliminary cost-utility analyses (CUA) of prosthetic care innovations can be routinely performed. The basic framework of preliminary CUAs and hands- on recommendations suggested previously might contribute to wider adoption. However, a practical application for an emerging intervention is needed to showcase the capacity of this proposed preliminary CUA framework. This study presented the outcomes of preliminary CUA of the distal weight bearing Keep Walking Implant (KWI), an emerging prosthetic care innovation that may reduce socket fittings for individuals with transfemoral amputation. The preliminary CUAs compared the provision of prosthetic care without (usual intervention) and with the KWI (new intervention) using a 15-step iterative process focused on feasibility, constructs, analysis, and interpretations of outcomes from an Australia government prosthetic care perspective over a six-year time horizon. Baseline and incremental costs were extracted from schedules of allowable expenses. Baseline utilities were extracted from a study and converted into quality-adjusted life-year (QALY). Incremental utilities were calculated based on sensible gains of QALY from baselines. The provision of the prosthetic care with the KWI could generate an indicative incremental cost-utility ratio (ICUR) of -$36,890 per QALY, which was $76,890 per QALY below willingness-to-pay threshold, provided that the KWI reduces costs by $17,910 while increasing utility by 0.485 QALY compared to usual interventions. This preliminary CUA provided administrators of healthcare organizations in Australia and elsewhere with prerequisite evidence justifying further access to market and clinical introduction of the KWI. Altogether, this work suggests that the basic framework of the preliminary CUA of a prosthetic care innovation proposed previously is feasible and informative when a series of assumptions are carefully considered. This study further confirms that preliminary CUAs prosthetic care interventions might be a relevant alternative to full CUA for other medical treatments.
RESUMO
Aproximadamente una tercera parte de los pacientes con una amputación transfemoral van a padecer problemas crónicos relacionados con el encaje de su prótesis. El 72% de los pacientes amputados refieren sudoración o sensación de calor por culpa del encaje, el 62% reportan lesiones cutáneas o irritaciones de la piel del muñón, el 53% fatiga del muñón, el 51% dolor del muñón y el 38% acaban abandonando el uso de la prótesis. La osteointegración es una técnica que evita estos problemas generados en la piel del paciente, ya que permite un anclaje directo de la prótesis al implante intramedular colocado en el fémur del paciente. Presentamos el caso de una paciente amputada transfemoral de 38 años tratada mediante una cirugía de osteointegración con el implante Keep Walking Advanced® para mejorar el uso de la prótesis sin la necesidad de encaje (AU)
Approximately one third of patients with a transfemoral amputation will have chronic problems related to the fitting of the prosthesis. More than two thirds (72%) of amputees report sweating or feeling hot because of the socket, 62% report skin lesions or skin irritation of the stump, 53% stump fatigue, 51% stump pain and 38% do not use the prosthesis. Osseointegration is a technique that avoids these problems in the patient's skin, allowing direct anchoring of the prosthesis to the intramedullary implant placed in the patient's femur. We report the case of a 38-year-old transfemoral amputee who underwent implantation of the Keep Walking Advanced® implant to improve the use of the prosthesis without the need for socket fitting (AU)
