Costs Associated with Lower- and Upper-Limb Amputation Over the First 4 Years with a Prosthesis
Authors: Wanamaker Andrea B. , Andridge Rebecca R. , Chaudhari Ajit M.W. 
Published: March 2020

ABSTRACT

Introduction
The impact of amputation on health care costs is an understudied topic due to the lack of sufficient population size and data sources. The purpose of this investigation was to leverage a publicly available database on amputations to determine health care–associated costs for individuals with lower- and upper-limb amputation of varying limb loss levels during the first 4 years after receipt of their first prosthesis.

Materials and Methods
An insurance claims database was obtained via public records request from the Ohio Bureau of Workers' Compensation for persons who suffered a traumatic injury in the workplace that resulted in lower- or upper-limb amputation. Data included information on cost and frequency of prosthetic limbs, equipment, and appointments, as well as information on general hospital care, physical, vocational, and mental health therapies, prescription medication, and additional health care categories. The population was categorized into five limb loss levels: individuals with unilateral transfemoral and transtibial amputation, as well as individuals with hand, below-elbow, and above-elbow amputation. Prosthetic claim codes were examined to determine the types of prostheses prescribed over time based on Medicare guidelines for activity levels (K1–K4) for lower-limb devices and by type (passive [cosmetic], body-powered, hybrid, or externally powered) for upper-limb devices. These data were used to determine short-term costs over the first 4 years, depending on the initial prosthesis prescription. Differences between total costs per year and over all 4 years were explored within each population to determine how initial prosthetic prescription impacts cost.

Results
In general, the microprocessor-controlled devices (i.e., microprocessor-controlled knee prostheses or externally powered upper-limb prostheses) resulted in higher initial prosthetic and total hospital costs, whereas the simpler mechanical devices (i.e., non–microprocessor-controlled knee prostheses or passive/cosmetic upper-limb prostheses) resulted in lower costs. Costs were highest in prosthetics-related expenses and physical therapy, especially in groups with the more advanced prostheses, during the first year after prosthesis receipt; however, the differences in costs based on prosthesis type minimized as time increased and few cumulative cost differences were seen over 4 years. In addition to determining costs accrued over time, the database provided insight into how frequently individuals with amputation received a new prosthesis and at what level. The average number of devices per person per year averaged 0.62 ± 0.36 for individuals with transfemoral amputation, 0.78 ± 0.40 for individuals with transtibial amputation, 0.24 ± 0.18 for individuals with hand amputation, 0.45 ± 0.39 for individuals with below-elbow amputation, and 0.40 ± 0.32 for individuals with above-elbow amputation.

Conclusions
The results of this cost investigation provide new information regarding all aspects of health care for individuals with lower-limb amputation and upper-limb amputation, respectively, who suffer from occupation-related traumatic amputation. The results provide new data trends on prosthesis usage and highlight how prosthetic prescription may alter these costs. The results suggest that there are no statistical differences in cost outcomes after 4 years, indicating that paying more initially for a more advanced prosthesis does not result in higher initial costs over time than paying less initially for a simpler prosthesis.