Economic evaluation of upper limb prostheses in the Netherlands including the cost-effectiveness of multi-grip versus standard myoelectric hand prostheses.

This was a survey, not a trial that assigned people to prostheses, so it cannot show that one prosthesis type caused the cost or outcome differences. Only 28 participants used a multi-grip myoelectric hand most, compared with 78 using a mono-grip hand, so the main comparison rests on a small group. Many participants did not know acquisition or repair costs, and those missing costs were replaced by expert estimates. The one-year costs were self-reported, which can increase recall bias, and participants reported costs from the most recent year, not the first year after prescription, which may underestimate costs. The paper could not calculate a response rate, did not have information on non-respondents, and may not have removed all duplicate surveys. Twenty-one percent of participants had more than one prosthesis, but they were asked about the one they used most. The PUF-ULP was a new measure, and its weights were estimated from 171 responses, a modest sample with imprecise weights. The results apply mainly to the Netherlands, where healthcare costs and reimbursement differ from other countries.

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Do not conclude that multi-grip hands are worse for every user. The health-related quality-of-life and preferred usage feature scores did not differ significantly between prosthesis types, and the paper says the cost-effectiveness finding is based on group averages, so some individual users may still benefit.