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Clinical Benefits

• The main clinical benefit of MPKs is derived from reductions of falls with injuries and osteoarthritis incidences. The computer software in MPKs allows for the knee to dynamically adjust to uneven terrain, leading to improved stability and user confidence. The increased stability is thought to reduce cognitive burden and energy expenditure. The combination of these aspects is assumed to reduce the risk of falls. Because MPK users are two times less likely to become a faller, MPK users avoid fall-related injuries, mortalities, and expenses.
• MPK users gain about 0.09 life years per person over a ten-year time period compared with NMPK users, but about 0.91 quality-adjusted life years per person, with the difference attributed to the improvement in quality of life. This finding is consistent with prior evidence that MPKs are associated with improved mobility, safety, user confidence, activities of daily living, ability to live independently, and satisfaction, and thus substantially better quality of life for amputees, with improvements ranging from 10 percent to 37 percent.

Economic Benefits

• MPKs are associated with a reduction of $3,676 per person per year in direct health care costs and $909 per person per year in indirect costs, such as lost wages and caregiving expenses.
• Because of the higher cost of MPK devices, overall annual cost is $15,083 per MPK patient and $13,382 per NMPK patient, a net increase of $1,702 based on current payment levels for devices and repair services.
• It appears that the economic benefits of MPKs are comparable to those of total knee replacement and better than the implantable cardioverter defibrillator. Therefore, MPKs do provide good value for money from a societal perspective.

Due to recent advances in technologies, prosthetic knees and feet allow for more-dynamic movements and improve user quality of life, but payers have recently started questioning their value for money. To explore this issue, we simulated the differential clinical outcomes and costs of microprocessor-controlled knees (MPKs) compared with non-MPKs (NMPKs). We conducted a literature review of the clinical and economic impacts of prosthetic knees, convened technical expert panel meetings, and implemented a simulation model over a ten-year time period for unilateral transfemoral Medicare amputees with Medicare Functional Classification Levels of 3 and 4.

We found that compared with NMPKs, MPKs are associated with sizeable improvements in physical function and reductions in incidences of falls and osteoarthritis. Our simulation results show that over a ten-year time period, compared with NMPKs, MPKs are associated with an incremental cost of $10,604 per person and an increase of 0.91 quality-adjusted life years per person, resulting in an incremental cost of $11,606 per quality-adjusted life year gained. The results suggest that the economic benefits of MPKs are in line with commonly accepted criteria for good value for money and with those of other medical devices that are currently covered by U.S. payers.

• Chapter One

  Introduction

• Chapter Two

  Methods

• Chapter Three

  Results

• Chapter Four

  Discussion

• Chapter Five

  Conclusion