HEALTH ECONOMIC EVALUATION OF MICROPROCESSOR AND NON-MICROPROCESSOR CONTROLLED PROSTHETIC KNEES

BACKGROUND: Use of a microprocessor-controlled knee (MPK) compared to a non-microprocessor-controlled knee (NMPK) can lead to improved walking ability, confidence and satisfaction. However, the MPK is more expensive than the NMPK and it is unknown whether the higher costs outweigh the potential benefits. OBJECTIVE: To evaluate the cost-utility and cost-effectiveness of MPKs and NMPKs from a societal perspective in the Netherlands. METHODOLOGY: Participants completed the Dutch version of the EuroQol - five dimensions - five levels (EQ-5D-5L) to assess health-related quality of life, three subscales (ambulation, utility and well-being) of the Prosthesis Evaluation Questionnaire (PEQ) to assess prosthesis-related quality of life and a cost-questionnaire from societal perspective. Incremental cost-utility ratio (ICUR) and incremental cost-effectiveness ratio (ICER) were calculated and the ICUR was compared with the Dutch willingness-to-pay threshold. Bootstrapping was used to estimate statistical uncertainty, and multiple imputation was applied to account for missing values. FINDINGS: In total, 111 participants were included (37 female, 73 male, 1 unknown; 71 transfemoral, 39 knee disarticulation, 1 unknown; age 64 ± 13 years; 49 NMPK users, 62 MPK users). The cost-utility analysis demonstrated that the MPK yielded an increase of 0.032 quality adjusted life years (QALY) but at considerably higher costs. The mean cost difference was € 14,626, resulting in a mean ICUR of € 457,063 per QALY gained. The cost difference was mainly driven by acquisition costs but was partially compensated by lower costs of work absence, health care consumption and household care. CONCLUSION: The cost-effectiveness analyses demonstrated that the MPK is likely to provide benefits in term of prosthesis-specific quality of life, but at higher costs. However, short-term improvement in health-related quality of life was too small to result in substantial QALY gain to offset the higher costs of the MPK and result in an incremental cost-utility ratio below the generally accepted willingness-to-pay thresholds. Layman's Abstract In this study, we compared two types of prosthetic knees that are used by people with a lower limb amputation. One is a high-tech version that uses a built-in computer sensor to help control movement (called a microprocessor controlled knee or MPK) and the other is a simpler, mechanical version (called a non-microprocessor controlled knee or NMPK). MPKs can help people walk more easily and feel more confident, but have a much higher acquisition cost. We compared the costs and benefits of both types of knees by studying 111 people who were either using an MPK or NMPK in their daily life. They completed surveys about their health, how they felt about their prosthesis, their healthcare use and work. Results showed that the people using an MPK reported better experiences in terms of mobility and satisfaction with their prosthesis. However, while the MPK did also improve quality of life a little bit, the improvement was small compared to how much more it costs. While the MPK helped reduce some other costs like time of work and healthcare use, the overall benefit wasn’t enough to make it cost-effective by current standards in the Netherlands. In conclusion, while the MPK offers some advantages, they may not be enough to justify the higher price, at least not in the short term. More research could help us understand whether the benefits grow over time. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/45823/34424 How To Cite: Bosman C.E, van der Sluis C.K, Vrieling A.H, Geertzen J.H.B, Seves B.L, Groen H. Health economic evaluation of microprocessor and non-microprocessor controlled prosthetic knees. Canadian Prosthetics & Orthotics Journal. 2025; Volume 8, Issue 2, No. 3. https://doi.org/10.33137/cpoj.v8i2.45823 Corresponding Author: Charlotte E. Bosman, PhDAffiliation: Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.E-Mail: c.e.bosman@umcg.nlORCID ID: https://orcid.org/0000-0001-7950-5893

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