The cost of falls for transfemoral amputees can be substantial. According to a Mayo Clinic study published in Prosthetics and Orthotics International, investigators found that in the 6-month period after a fall that resulted in hospitalization, the fall-related expenses for transfemoral amputees were similar to those reported for elderly populations.
According to a press release from the Mayo Clinic, 25% to 30% of new amputees receive a prosthetic leg and knee. Although newer technology has been shown to reduce falls and improve physical capabilities, only high-functioning patients are eligible for knees with microprocessor technology. According to Benjamin Mundell, PhD, the lead author of the study, such knees are designed to improve balance and reduce the risk of falls.
“We want to help provide the best quality of life and prosthesis for each individual,” Mundell, who is a health economist and a medical student at Mayo Clinic School of Medicine, said in the release. “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.”
To record the direct medical costs of falls among adults with a transfemoral amputation, Mundell and his colleagues used the Rochester Epidemiology Project — which includes a collection of records from Minnesota and Wisconsin — to study the records of 77 patients who underwent a transfemoral amputation between 2000 and 2014. Of these patient, 46 received a prosthetic knee. Of those, 22 patients had 31 falls that resulted in hospitalization or a visit to the emergency department. Patients who fell more than once during an 18-month period had both incidents excluded from the cost analysis, to prevent misalignment of costs.
According to the release, the additional cost for falls among transfemoral amputees who required a visit to the emergency department was $18,000. For those who required hospitalization, the additional cost was more than $25,000.
“Value is the new metric in health care as we try to contain costs,” Mundell said in the release. “Part of understanding the value of advanced medical devices is measuring what future costs they can help patients avoid. Measuring the quality of life a device provides for each individual is difficult. We focused on the costs of falls — events that microprocessor knees are designed to help avoid. A policymaker or payer can then look at the cost of a device and compare it to the cost of an adverse event that the device can prevent when deciding whether or not the device offers additional value.”
Mundell B, et al. Prosthet Orthot Int. 2017;doi: 10.1177/0309364617704804.
Disclosure: The researchers report support from the American Orthotic and Prosthetic Association, the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, and the Rochester Epidemiology Project.