Economic Value of Orthotic and Prosthetic Services Among Medicare Beneficiaries: A Claims-Based Retrospective Cohort Study, 2011–2014

Abstract

Background: There are few studies of the economic value of orthotic and prosthetic services. A prior cohort study of orthotic and prosthetic Medicare beneficiaries based on Medicare Parts A and B claims from 2007 to 2010 concluded that patients who received timely orthotic or prosthetic care had comparable or lower total health care costs than a comparison group of untreated patients. This follow-up study reports on a parallel analysis based on Medicare claims from 2011 to 2014 and includes Part D in addition to Parts A and B services and expenditures. Its purpose is to validate earlier findings on the extent to which Medicare patients who received select orthotic and prosthetic services had less health care utilization, lower Medicare payments, and potentially fewer negative outcomes compared to matched patients not receiving these services. Methods: This is a retrospective cohort analysis of 78,707 matched pairs of Medicare beneficiaries with clinical need for orthotic and prosthetic services (N = 157,414) using 2011-2014 Medicare claims data. It uses propensity score matching techniques to control for observable selection bias. Economically, a cost-consequence evaluation over a four-year time horizon was performed. Results: Patients who received lower extremity orthotics had 18-month episode costs that were $1939 lower than comparable patients who did not receive orthotic treatment ($22,734 vs $24,673). Patients who received spinal orthotic treatment had 18-month episode costs that were $2094 lower than comparable non-treated patients ($23,560 vs $25,655). Study group beneficiaries receiving both types of orthotics had significantly lower Part D spending than those not receiving treatment (p < 0.05). Patients who received lower extremity prostheses had comparable 15-month episode payments to matched beneficiaries not receiving prostheses ($68,877 vs $68,893) despite the relatively high cost of the prosthesis. Conclusions: These results were consistent with those found in the prior study and suggest that orthotic and prosthetic services provide value to the Medicare program and to the patient.

Cost-Effectiveness of Transtibial Bone-Anchored Prostheses Using Osseointegrated Fixation: From Challenges to Preliminary Data

“…Such study has a place in the scheme of things but provides a limited understanding of overall economic benefits. The prosthetic costs occurring during the first 6 years of the treatment represents a fraction of the whole health care costs taking also into consideration surgical and medical costs 29,37,43–46,61 …”

“…One could consider that an indicative ICER below $20,000 per QALY might make the treatment most likely to be adopted, particularly by Australian governmental prosthetic care providers. However, more cost-effectiveness information from health care perspective considering surgical, medical, and prosthetic care costs is needed to establish if the treatment could be adopted more widely by a broader range of health care providers 29,36,43–46,62 …”

“…In principle, the methods developed in these studies should be transferable to specific cost-effectiveness analyses of TTA-BAP from either governmental prosthetic care or national health care perspectives. 29,32,40,[43][44][45][46] However, the cost-effectiveness of TTA-BAP could be challenging to unravel depending on how much of the clinical pathways are funded by health care systems. Surgical, medical, rehabilitation, and prosthetic care costs could be covered in part or in whole by patients themselves and other private or public organizations.…”

“…Conducting an analysis from a governmental prosthetic care perspective seems a timely and relevant starting point. 39,40,44,45 In the short term, there is an immediate need for an initial cost-effectiveness study of this kind to establish the feasibility while describing the challenges that could be met and eventually presenting preliminary outcomes (e.g., cost, utility, ICER). Lessons learnt from this experience could educate the design of subsequent comprehensive cost-effectiveness studies.…”

Race and Insurance Status Association With Receiving Orthopedic Surgeon-Prescribed Foot Orthoses

“…6,8,17,19,22,23,31,32 Furthermore, orthoses may ultimately lead to less expensive episodes of care and better overall health status outcomes. 9,12 Despite the proven efficacy of this treatment modality, many patients with these conditions do not use orthoses. 16,20,26-28…”