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Prosthetic Knee Type May Impact Cost of Care

Despite growing data that more advanced technology reduces
falls and improves physical capabilities among patients with
transfemoral amputations, patients with lower K-levels are usually
ineligible for a microprocessor knee. Access to improved knee technology
can help patients become more agile, more balanced, and less likely to
fall; without access to such technology, they may become more vulnerable
and less active. A study published June 22 in Prosthetics and Orthotics International
described the direct medical costs of falls in adults with a
transfemoral amputation to provide policymakers with information to
evaluate the value of more expensive technology, according to the
researchers. Using standardized Medicare cost data, they found that the
average additional cost in the six months following a fall can be
substantial. The additional fall cost for individuals requiring an
emergency department visit was $18,000. For patients who had to be
hospitalized, this extra expense was more than $25,000.

“It is
important to look beyond the initial cost differences of a
microprocessor knee compared to a mechanical knee and understand what
downstream costs might be avoided with a better prosthesis,” said
Benjamin Mundell, PhD, a health economist and the study’s lead author.
“Microprocessor knees are designed to help improve balance and reduce
falls,” he says. “The fear of falling for those with mechanical knees
likely reduces their overall physical activity and if they do fall and
require hospitalization, the cost of care is almost as expensive as a
microprocessor knee.”

Using the Rochester Epidemiology Project, a
health records linkage collaboration in Minnesota and Wisconsin, the
team examined the records of 77 individuals who received a transfemoral
amputation between 2000 and 2014. They found that 46 of these patients
had received a prosthetic knee. Of these, 22 individuals experienced 31
falls that resulted in an emergency department visit or hospitalization.
If they fell more than once during an 18-month period, both incidents
were excluded from the cost analysis to prevent misalignment of costs.

the costs is part of basic health economics,” says Kenton Kaufman, PhD,
PE, the study’s senior author, who is a biomedical engineer and
orthopedics researcher at Mayo Clinic, Rochester, Minnesota. “This study
quantifies the cost of falls that require medical attention—providing
evidence that it may not be economical to withhold microprocessor knees
from patients with moderate ambulatory capabilities.”

Kaufman believes the costs to patients are much higher than the study shows.

know our cost estimate underestimates the true cost of a fall, because
we didn’t include indirect costs, such as lost wages, caregiving
expenses, and transportation costs,” he said.

“Value is the new
metric in healthcare as we try to contain costs,” said Mundell. “Part of
understanding the value of advanced medical devices is measuring what
future costs they can help patients avoid.”

Editor’s note: This story was adapted from materials provided by the Mayo Clinic.

To read more about Kaufman’s research using Rochester Epidemiology Project data, visit “O&P Research Supports Evidence-Based Care” in the March 2017 issue of The O&P EDGE.