Health Economics in the Field of Prosthetics and Orthotics: A Global Perspective

Abstract

The rapid advancement of prosthetic and orthotic (P&O) technology raises the question how the industry can ensure that patients have access to the benefits and providers get paid properly and fairly by healthcare payers. This is a challenge that not only P&O but all areas of health technology face. In many areas of medicine and health products, such as drugs and medical devices, health-technology assessments (HTA) have become a standard procedure in the coverage and reimbursement process. In most countries, P&O is lagging behind that development, although some countries have already formalized HTA for prosthetic and orthotic products and may even use cost-effectiveness analyses to determine pricing and payment amounts. This article gives an overview on the coverage and reimbursement processes in the United States, Canada, Germany, France, Sweden, the United Kingdom, Poland, Japan, and China. This selection reflects the variety and diversity of coverage and reimbursement processes that the P&O industry faces globally. The paper continues with an overview on the necessary research and investment efforts that manufacturers will have to make in the future, and contemplates the likely consequences for the manufacturer community in the market place. Health economics may help support the transition from price-based to value-based coverage and reimbursement but will come at considerable costs to the industry.
 Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/35298/28317
 How To Cite: Kannenberg A, Seidinger S. Health economics in the field of prosthetics and orthotics: A global perspective. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, No.6. https://doi.org/10.33137/cpoj.v4i2.35298
 Corresponding Author: Andreas Kannenberg, MD (GER), PhDExecutive Medical Director North America, Otto Bock Healthcare LP, 11501 Alterra Parkway, Suite 600, Austin, Texas, USA.E-Mail: andreas.kannenberg@ottobock.comORCID ID: https://orcid.org/0000-0001-7983-1744

Improving access to prosthetic limbs in Germany: An explorative review

“…Health technology assessment as a standardized procedure and toolbox for evaluating the benefits and costs of medical technologies has been suggested as a potential response to economic pressures in prosthetic care. 20 According to WHO Standards 9/10, planning and budgeting should be based on a comprehensive analysis of costs and benefits . 21 An inclusive co-development of research designs by target groups, HTA, manufacturers, and insurers would be highly beneficial in this step.…”

“…Ethical principles for the process and criteria of rationing 35 need to be implemented, and there is a need for a broader societal discussion on this topic. 20 …”

Advances in prosthetic technology: a perspective on ethical considerations for development and clinical translation

“…To prosthetic users and clinicians alike, cost is a crucial concern and must be accounted for in prosthetic technology development ( 31 , 36 , 41 , 42 , 71 ). As all authors are based in the US, only US coverage guidelines will be discussed, though international challenges in prosthetic coverage have also been reported ( 72 ). Kannenberg et al discuss how insurance companies (including the Centers for Medicare and Medicaid services) have recently called for greater evidence with high-quality methods to document the clinical benefit of prosthetic technology and guide payment rates ( 72 , 73 ).…”

“…As all authors are based in the US, only US coverage guidelines will be discussed, though international challenges in prosthetic coverage have also been reported ( 72 ). Kannenberg et al discuss how insurance companies (including the Centers for Medicare and Medicaid services) have recently called for greater evidence with high-quality methods to document the clinical benefit of prosthetic technology and guide payment rates ( 72 , 73 ). Although it is difficult to mask participants and randomize study groups in prosthetics research, high-quality evidence is crucial to justify the need and subsequent reimbursement of prosthetic technology.…”

“…As manufacturers and developers continue to produce novel technologies, the cost of high-quality research can be priced into the product to account for this need. Additionally, insurance companies can dictate whether cheaper technologies provide equal benefit and will therefore be sufficient for the patient ( 72 ). Thus, new prosthetic technology must have a documented added benefit in order to receive adequate reimbursement, and developers and manufacturers should await the publication of this documented benefit prior to marketing the technology.…”