Cost-Effectiveness of C-Leg Compared to Non Microprocessor Controlled Knees
Posted: 3 Jul 2007
INTRODUCTION: Studies has proven that the microprocessor controlled prosthetic knee, the C-Leg, is associated with several advantages in comparison to the conventional non-microprocessor knee units. However, as the C-Leg is substantially more costly compared to the non-microprocessor controlled alternatives, the potential benefits need to be compared with the increased costs as cost-effectiveness has become a key criteria for decision-makers when deciding which health-care interventions should be made available in collectively funded health-care systems. Although little clinical evidence exists, decision makers still have to make recommendations regarding the provision of C-leg and therefore the purpose of this study was to estimate the costs and health outcomes of C-Leg and non-microprocessor controlled knees employing a decision model based on available evidence and newly collected data on health-related quality of life of patients with C-leg.
METHOD: A decision-analysis Markov model was created. The costs, rate and duration of problems, knee survival and quality-adjusted life-years were obtained from interviews with 20 patients and 5 prosthetist with experience of both C-leg and non microprocessor controlled knees. According to recent guidelines, the model was analyzed using second-order Monte-Carlo simulation in order to reflect uncertainty in the model inputs. The analysis was undertaken from a Swedish health-care perspective. Main outcome measures where cost (in 2006 Euros) per quality-adjusted life-year gained by providing a transfemoral amputee with C-leg as opposed to a non microprocessor controlled knee.
RESULTS: The analysis resulted in a mean incremental cost for C-Leg of 7 657 and 2.38 incremental quality-adjusted life-years gained, yielding a cost per quality-adjusted life-year gained of 3 218.
CONCLUSION: In conclusion, we have argued for the importance of providing decision makers with relevant information on costs and health outcomes of different treatment strategies on actual decision problems even when limited evidence exists. We have provided results where costs and a broadly defined health outcome in term of quality-adjusted life years have been estimated showing that given existing evidence C-leg appear to yield positive health outcomes at an acceptable cost. The utilization of Bayesian expert elicitation to achieve better priors could be of significant interest in future research.
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