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Cost-effectiveness of C-Leg compared to non microprocessor controlled knees: a modeling approach
Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Arts and Sciences.
2008 (English)In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 89, no 1, 24-30 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To estimate the costs and health outcomes of C-Leg and non–microprocessor-controlled (NMC) knees using a decision-analytic model.

Design: Data on costs, rates and duration of problems, knee survival, and health-related quality of life were obtained from interviews with patients and prosthetists with experience of both C-Leg and NMC knees. Interview data were assessed in a decision-analytic Markov model to estimate cost-effectiveness from a health care perspective.

Setting: Outpatient.

Participants: A population sample of 20 patients currently using the C-Leg and prior experience of nonmicroprocessor knees, and 5 prosthetists.

Interventions: Not applicable.

Main Outcome Measure: Incremental cost per quality-adjusted life year (QALY).

Results: The mean incremental cost (in 2006 Euros) and QALYs for the C-Leg was €7657 and 2.38, respectively, yielding a cost per QALY gained of €3218.

Conclusions: It is important to provide decision-makers with relevant information on costs and health outcomes of different treatment strategies on actual decision problems despite limited evidence. The results of the study, taking into account both costs and a broadly defined health outcome in terms of QALY, show that given existing albeit limited evidence the C-Leg appears to yield positive health outcomes at an acceptable cost.

Place, publisher, year, edition, pages
Institutionen för medicin och hälsa , 2008. Vol. 89, no 1, 24-30 p.
Keyword [en]
Artificial limbs, Costs and cost analysis, Decision support techniques, Quality of life, Rehabilitation
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-11142DOI: 10.1016/j.apmr.2007.07.049OAI: oai:DiVA.org:liu-11142DiVA: diva2:17582
Note
Original publication: Thor-Henrik Brodtkorb, Martin Henriksson, Kasper Johannesen-Munk, Fredrik Thidell, Cost-effectiveness of C-Leg compared to non microprocessor controlled knees: a modelling approach, 2008, Archives of Physical Medicine and Rehabilitation, (89), 1, 24-30. http://dx.doi.org/10.1016/j.apmr.2007.07.049. Copyright: Elsevier B.V., http://www.elsevier.com/Available from: 2008-02-27 Created: 2008-02-27 Last updated: 2017-12-13
In thesis
1. Cost-effectiveness analysis of health technologies when evidence is scarce
Open this publication in new window or tab >>Cost-effectiveness analysis of health technologies when evidence is scarce
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Given the increasing pressures on health care budgets, economic evaluation is used in many countries to assist decision-making regarding the optimal use of competing health care technologies. Although the standard methods of estimating cost-effectiveness underpinning these decisions have gained widespread acceptance, concerns have been raised that many technologies would not be considered for funding, due to scarcity of evidence. However, as long as the amount and quality of evidence used for the analysis are properly characterized, scarce evidence per se should not be seen as a hindrance to perform cost-effectiveness analyses. Characterizing uncertainty appropriately, though, may pose a challenge even when there is a large body of evidence available, and even more so when evidence is scarce. The aims of this thesis are to apply a methodological framework of cost-effectiveness analysis and explore methods for characterising uncertainty when evidence is scarce. Three case studies associated with limited evidence provide economic evaluations on current decision problems, investigate the feasibility of using the framework, and explore methods for characterizing uncertainty when evidence is scarce.

The results of the case studies showed that, given current information, providing transfemoral amputees with C-Leg and Airsonett Airshower to patients with perennial allergic asthma could be considered cost-effective whereas screening for hyperthrophic cardiomyopathy among young athletes is unlikely to be cost-effective. In the cases of C-Leg and Airsonett Airshower conducting further research is likely to be cost-effective. The case studies indicate that it is feasible to apply methods of cost-effectiveness in health care for technologies not commonly evaluated due to lack of evidence. The analysis showed that failing to account for individual experts’ might have a substantial effect on the interpretation of the results of cost-effectiveness analysis. Formal expert elicitation is a promising method of characterizing uncertainty when evidence is missing, and thus enable cost-effectiveness and value of further research to be appropriately estimated in such situations.

In conclusion, this thesis shows that scarcity of evidence should not preclude the use of cost-effectiveness analysis. On the contrary, in such cases it is probably more important than ever to use a framework that enable us to define key parameters for a decision problem and identify available evidence in order to determine cost-effectiveness given current information and provide guidance on further data collection.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2010. 41 p.
Series
Linköping Studies in Science and Technology. Dissertations, ISSN 0345-7524 ; 1324
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-56595 (URN)978-91-7393-363-6 (ISBN)
Public defence
2010-06-18, Aulan i Hälsans hus, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Opponent
Supervisors
Note
In the list of included articles in the Ph.D. thesis the title of manuscript IV is "Cost-effectiveness of screening for hypertrophic cardiomyopathy in young athletes" but the title of the included article in the Ph.D. thesis is "Screening for hypertrophic cardiomyopathy in young athletes: A cost-effectiveness analysis".Available from: 2010-05-26 Created: 2010-05-26 Last updated: 2010-05-26Bibliographically approved

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Brodtkorb, Thor-HenrikHenriksson, Martin

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