Cost-effectiveness of lower limb prosthetic devices for mobility in older adults with dysvascular amputations

Background: There is limited consensus regarding the economic value of prosthetic devices with advancing age. We aimed to meet this knowledge gap by studying the cost-effectiveness of lower limb prostheses (LLPs) for older adults with dysvascular amputations. Methods Design: We constructed a decision analytic model nested with Markov models with a lifetime horizon to compare LLP recipients (LLP) with non-recipients (no-LLP) from a health care sector perspective. A 3% annual rate was applied to obtain the present value of the main outcome measures. One-way sensitivity analyses that modeled clinically extreme scenarios were conducted on LLP cost, change, abandonment rate, fall rate, mortality, and utility. Data sources: Model parameters were obtained from literature, with many source studies utilizing Medicare data and focusing on dysvascular amputations. Parameters included the "annual probability" of fall, LLP abandonment and mortality, costs associated with decreased physical inactivity or deconditioning, falls (rate and cost), abandonment (rate), mortality, and "utilities associated" with Markov model health states. All costs were adjusted to 2022 price levels. Intervention: Lower limb prosthesis. Main Outcome Measures: Lifetime cost, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio (ICER). Results: The LLP group incurred a lifetime cost of $36,789 and yielded 4.54 QALYs. The no-LLP group incurred a lifetime cost of $23,909 and yielded 2.58 QALYs. The ICER was $6588/QALY, which is below the most conservative willingness-to-pay threshold of $50,000/QALY and indicated that LLP was cost-effective compared with no-LLP. Sensitivity analyses for increasing LLP replacement to annual (ICER = $33,477/QALY), abandonment rate to 22% (ICER=$6367), fall rate to 70% (ICER = $7140/QALY), and increasing No-LLP EuroQol-five-dimension to 0.71 (ICER = $10,819/QALY) were all below the willingness-to-pay as well. Conclusions: LLP for older adults with dysvascular amputations was cost-effective for most clinically realistic scenarios.