Economic Value of Prosthetic Services among Medicare Beneficiaries: A Claims-Based Retrospective Cohort Study

Abstract

Context There are few studies of the economic impact or value of lower extremity prosthetic services. Results from this study can inform the value proposition concerning prosthetic services within military health, where over 40,000 Veterans with limb-loss receive care for their amputations through the Veterans Administration health care system. Purpose To determine the extent to which Medicare patients who received selected prosthetic services had less health care utilization, lower Medicare payments, and/or fewer negative outcomes compared to matched patients not receiving these services. Methods This retrospective cohort analysis using Medicare claims data (2007–2010) and propensity score matching techniques to control for observable selection bias based on etiological diagnosis, comorbidities, patient characteristics, and historical health care utilization one year before the etiological diagnosis. Findings: Patients who received lower extremity prostheses had comparable Medicare episode payments ($6,099 per-member-per-month for study group, $6,015 per-member-per-month for comparison group) and better outcomes than patients who did not receive prostheses. Study group patients were more likely to receive extensive outpatient therapy than comparison group patients ( P < 0.05). Receiving physical therapy is associated with fewer hospitalizations and emergency room visits, and less facility-based care ( P < 0.05), essentially offsetting the cost of the prosthetic over a 12-month time frame.

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.…”

Methods for estimating the cost of treat‐and‐release emergency department visits

“…Billing charges do not reflect the true cost of providing services, in part because hospitals do not apply a fixed mark-up to costs. 9 The traditional approach is to apply a hospital-level cost-to-charge ratio (CCR) to convert ED charges into estimated costs, but hospital-wide CCRs may be inaccurate for individual departments such as the ED. 10 The Medicare Hospital Outpatient Prospective Payment System implements the most prevalent application of CCR methods in use today to estimate the cost of providing ED services at different levels of visit intensity.…”