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An Introduction to the Proceedings of the AAOP’s State-of-the-Science Conference on the Economic Science of Lower-Limb Prosthetic Rehabilitation

Stevens, Phillip M. MEd, CPO, FAAOP; Highsmith, M. Jason PhD, DPT, CP, FAAOP

JPO: Journal of Prosthetics and Orthotics: January 2019 - Volume 31 - Issue 1S - p P1–P2
doi: 10.1097/JPO.0000000000000233

Disclosure: The authors declare no conflict of interest.

Recent years have witnessed an increased interest in the economic science associated with prosthetic rehabilitation. This has been evidenced in a series of economic publications, reports, and analyses. Recognizing the increasing relevance of economics in health care policy and decision making, the American Academy of Orthotists and Prosthetists held a State-of-the-Science Conference on November 2–3, 2017, on this important topic. Several of the presenters shared materials created through recent collaborations with the American Orthotic and Prosthetic Association. The participation of both organizations in this event allowed for a comprehensive consideration of all available economic publications in a single setting. The following proceedings include reprints of relevant economic publications, multidisciplinary perspective pieces, and an introduction to economic science for those working in rehabilitation of individuals with amputation.

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The proceedings begin with two systematic reviews encompassing the existing body of economic science in prosthetic science through November 2015. The first comprises a scoping review of the small number of available evaluations germane to transtibial prosthetic care, whereas the latter is a narrative review of descriptive economic literature through the same period.

These reviews are followed by an introduction to health care economics for those working in prosthetic rehabilitation in which prosthetic publications and applications are described in economic terms and principles. This includes introductions to the concepts of value and value assessment, economic evaluation strategies of benefit, consequence, effectiveness and utility, quality-adjusted life years, incremental cost-effectiveness ratios, and willingness-to-pay thresholds. This is followed by a perspective piece on the value of prosthesis-enabled mobility inclusive of the impact of mobility on quality of life, its role in the avoidance of negative outcomes associated with prolonged immobilization, the burden of disease associated with limb loss as characterized by disability-adjusted life years, and the health benefits associated with physical activity with a prosthesis.

These broad introductory pieces are followed by more focused perspective pieces from the consumer, the provider, and the manufacturer with respect to economic considerations in prosthetic rehabilitation. A supplemental perspective piece representing international economic approaches and considerations is also considered.

These perspective pieces are followed by reprints of three of the most recent and influential economic analyses, all commissioned by the American Orthotic and Prosthetic Association. These include retrospective analyses of Medicare claims data by Dobson et al. and an economic modeling exercise on the impact of microprocessor knees on individuals with transfemoral amputation performed by the RAND group.

Collectively, this material represents a current, comprehensive consideration of available economic principles and data as they pertain to lower-limb prosthetic rehabilitation. The hope is that this document will usher in an increased awareness of the relevance of economic considerations in future clinical trials and coverage policies.

© 2019 by the American Academy of Orthotists and Prosthetists.