Economic evaluation of upper limb prostheses in the Netherlands including the cost-effectiveness of multi-grip versus standard myoelectric hand prostheses

Abstract

Purpose

To 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 methods

The 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.

Results

The mean yearly total costs related to prosthesis use of MHPs (€54 112) and SHPs (€23 501) were higher compared to prostheses with tools/accessories (€11 977), body-powered (€11 298), and cosmetic/passive prostheses (€10 132). EQ-5D-5L and PUF-ULP scores did not differ between prosthesis types. ICUR was €-728 833 per quality-adjusted life year; ICER was €-187 798 per PUF-ULP point gained.

Conclusions

Myoelectric 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.

Implications for Rehabilitation

• Myoelectric upper limb prostheses, especially the multi-grip hands, were more expensive than all other types of upper limb prostheses.

• Health-related quality of life and user experiences were comparable in users of different types of upper limb prostheses.

• Acquisition costs mainly explained the differences in costs related to upper limb prosthesis use.

• Prescription of multi-grip hand prostheses should be considered carefully, since these are not cost-effective compared to standard myoelectric hand prostheses.

Keywords:

• Upper extremity
• prostheses
• amputation
• artificial limbs
• questionnaire
• costs and cost analysis
• quality of life
• patient reported outcome measures

Acknowledgements

The authors would like to thank V. Schuurmans, L. Boerema, A. Hoogerkamp, and C.J. Blekkink for administrative and logistic work. Furthermore, we would like to thank all people from participating rehabilitation centres and orthopaedic workshops who helped to send the surveys: M.A.H. Brouwers, A. Rijkse, and O. Rijnders from the Hoogstraat Rehabilitation; W.G.M. Janssen from Rijndam Rehabilitation Centre; M. Heurman and J.S. Rietman from Roessingh Centre for Rehabilitation; N.D.M. Ringeling-van Leusen and C. Vervoort from Revant Rehabilitation Centre; J.W.E. Verlouw from Adelante Rehabilitation; C. Utens and D. ten Haaf from Libra Rehabilitation & Audiology; A. van der Grijn and S.M. Brink from Vogellanden, Centre of Rehabilitation Medicine & Special Dentistry; T.C.H. Singer, I. Vermeulen, and A.M. van de Ven from Military Rehabilitation Centre Aardenburg; E. Mik, M. Ruiter-Geurts, W. Akkerman, and K. Steinbach from Livit Orthopedie; C. Vergeer and R. van Willegen from OIM Orthopedie. Last, we would like to thank S. van Twillert and R.M. Bongers for their input in discussions about this study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

Data that support the findings of this study are available on DataVerseNL: https://doi.org/10.34894/TVITPL

Additional information

Funding

This study was funded by ZonMW (project number: 853001102). The funders had no role in study design and collection, analysis and interpretation of data and in writing the manuscript. Netherlands Organisation for Health Research and Development.