Health economic evaluation in orthotics and prosthetics: a systematic review protocol

Abstract

Background Health economic evaluations are essential to support health care policy and investment decisions. To date, health economic evaluations in orthotics and prosthetics have focused on discrete components of an orthosis/prosthesis (e.g. a microprocessor controlled prosthetic knee joint) rather than the broader service provided by orthotist/prosthetists. As such, the contribution to orthotic/prosthetic policy and investment decisions is unclear. Whilst there are opportunities to conduct more informative health economic evaluations that describe the costs and benefits of the orthotic/prosthetic service, it is important that prospective research is informed by a critical review of the method design challenges and an understanding of how this research can be improved. The aim of this systematic review is to critically appraise the existing orthotic/prosthetic health economic evaluation literature and therefore determine evidence gaps, critical method design issues and the extent to which the literature informs orthotic/prosthetic policy and investment decisions. Methods A comprehensive range of databases—AMED, EMBASE, MEDLINE and PsychINFO, Cumulative Index of Nursing and Allied Health Literature (CINAHL), ProQuest Nursing and Allied Health, Web of Science, Cochrane Database of Systematic Reviews (CDSR) and specialty health economic databases—will be searched using National Library of Medicine Medical Subject Headings (MeSH) terms as well as the title, abstract, and keyword terms. Search terms related to the intervention (e.g. orthosis), including variants used by varying professional disciplines (e.g. brace), will be used in preference to defining the populations that use orthotic and prosthetic services (e.g. people living with rheumatoid arthritis). Search terms related to health economic evaluations will be guided by previously developed and tested search strings and align with recommendations by the Canadian Agency for Drugs and Technologies in Health. Articles meeting the inclusion criteria will be hand-searched for relevant citations, and a forward citation search using Google Scholar will also be conducted to identify early online articles not yet indexed in traditional databases. Original research published in the English language and after 1 January 2000 will be included. The Checklist for Health Economic Evaluation Reporting Standards (CHEERS) and the Consensus on Health Economic Criteria (CHEC)-Extended list will be used to appraise the methodological quality and identify sources of bias. Data extraction and appraisal will be conducted by one reviewer independently using appraisal instrument guidelines and a content specific decision aid with exemplars. A subsequent review by a second researcher will be undertaken to confirm the accuracy of the extraction and appraisal, and a final review by a third where consensus cannot be reached. The data will be extracted to a purpose-built data extraction template with decision-making guidelines to support consi...

A systematic review of health economic evaluation in orthotics and prosthetics: Part 2—orthotics

“…The protocol for this systematic review was registered with PROSPERO (CRD42018116910) and published. 14 As such, a summary of the method has been reported in accord with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. 15…”

“…43 We extracted data for the 6 data sources that included an orthotic intervention but not for intervention studies outside the scope of this review. 43 As described in the protocol 14 and the Method section, a decision aid was developed to ensure consistent use of the CHEC-Extended. 25,26 We acknowledge the decision aid has not undergone rigorous testing or review.…”

“…A known bank of articles was used to assess the search yield and refine the search terms and strings as part of the protocol development. 14 Preliminary testing of the search did not yield any HEEs before the year 2000, and therefore searches were restricted to studies published in English between January 1, 2000 and January 1, 2019. Reference lists of included studies were hand-searched, and a Google Scholar forward citation search was conducted.…”

“…24 (p.4) Given the aforementioned operational definition of orthoses or prostheses, studies of internal devices (eg, hip and knee replacements) were excluded. 14 Similarly, studies were also excluded where the intervention under investigation was not provided by a recognized healthcare profession in which orthotic and/or prosthetic services were accepted as within the practitioner's scope of practice; acknowledging the substantial overlap in the scope of practice for several health professions (eg, occupational therapists and orthotists both provide upper limb orthotic services, and podiatrists and orthotists both provide foot orthotic services). 14 Studies were also excluded where there were simultaneous treatments forming a cointervention such that the study did not inform the cost-effectiveness of a discrete orthotic/prosthetic device or service.…”

Health Service Delivery and Economic Evaluation of Limb Lower Bone-Anchored Prostheses: A Summary of the Queensland Artificial Limb Service’s Experience

“…More importantly, these publications were considered and often cited in recent health technology assessments of osseointegrated prosthetic solutions produced by several government organizations (e.g., Australian states, Canadian provinces, United Kingdom, New Zealand, Spain). [34][35][36][37][38][39][40] This work provided guidance when the Australian National Disability Insurance Scheme developed its funding model.…”