Hansson E, Hagberg K, Cawson M, Brodtkorb TH. Patients with unilateral transfemoral amputation treated with a percutaneous osseointegrated prosthesis. Bone Joint J. 2018 Apr 1;100-B(4):527-34.

AIMS: To compare the cost-effectiveness of treatment with osseointegrated percutaneous prostheses (OI-prostheses) and socket-suspended prostheses (S-prostheses) for patients with transfemoral amputation in Sweden.

PATIENTS AND METHODS: A Markov model was developed to estimate the direct medical costs and changes in quality-adjusted life-years (QALYs) attributable to treatment of unilateral transfemoral amputation over a 20-year time horizon from a health care perspective. Data was collected alongside a prospective clinical study including 51 patients.

RESULTS: OI-prostheses had an ICER of €83,374 per QALY gained compared with S-prostheses. The clinical improvement seen with OI-prostheses was reflected in QALYs gained. Results were most sensitive to the utility value for both treatment arms. The impact of an annual decline in utility values of 1%, 2%, and 3%, for patients with S-prostheses resulted in a cost per QALY gained of €37,020, €24,662, and €18,952, respectively, over 20 years.

CONCLUSION: From a health care perspective, treatment with OI-prostheses have higher costs than that of S-prostheses. If decline in utility for the conventional care can be accounted for, the cost per QALY would be considerably reduced.

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