Economic benefits of microprocessor controlled prosthetic knees: a modeling study.
Christine Chen, Mark Hanson, Ritika Chaturvedi and 3 others
PMID 30255802WHAT IT FOUND
Microprocessor knees were modeled to be cost-effective and to cut major injurious falls by 79%, but total costs were higher and this is not trial evidence.
Key findings
01The model estimated that MPK users had 79% fewer major injurious falls than NMPK users, with fall-related death rates of 3 and 14 per 1000 person-years, respectively.
02The model found MPK more effective than NMPK in all simulated scenarios, but more costly in 83% of them; the base-case estimate was $11,606 per quality-adjusted life-year gained.
03Across the studies reviewed, MPK was associated with better walking speed, gait symmetry, obstacle negotiation, and safety, while energy efficiency and physical activity findings were inconclusive.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This was a model, not a direct patient comparison. There were no randomized trials comparing MPK and NMPK, and the studies used as inputs were often small and short-term. Some model inputs, including the proportion of medical falls, came from non-amputee populations. The osteoarthritis benefit was not measured directly; it was assumed from expert opinion about knee forces. The main analysis was for K3/K4 users, so results for K1/K2 users may not be reliable. The model used Medicare payment amounts rather than manufacturing costs, so the cost conclusion could change if payments change. The model stopped at 10 years and could not include long-term outcomes such as obesity, diabetes, or cardiovascular disease.
The easy way to misread this
Do not read the favorable cost-effectiveness estimate as proof that MPKs are clinically proven or always cost-saving. It is a modeled comparison based on short-term studies, expert assumptions, and Medicare payment amounts, and the base-case total cost was higher for MPK users.