Healthcare providers and insurance companies weigh various factors when faced with “Go” or “No-go” care decisions. Along with decidedly subjective factors such as quality of life, longevity, and emotional implications, objective cost considerations figure in the decision-making process, whether by formula, individual, or committee. Medical care is expensive no matter how you cut it. Funds are limited. There are times, however, when short-term savings result in higher costs over time. Researchers at the Mayo Clinic considered the subjective and objective factor confluence regarding decisions as to who gets approved for high-tech knee prosthetics.
According to the Amputee Coalition, more than 185,000 people in the U.S have amputations each year, about 3,500 every week. When it’s time to evaluate the patient’s suitability for a prosthesis, only highly-functioning patients qualify for prosthesis knees with microprocessors. According to the researchers, substantial data that high-tech prosthetic knees reduce falls and improve patients’ physical capabilities flies in the face of insurance approvals. In a study published in Prosthetics and Orthotics International, the Mayo Clinic research team studied the direct medical costs of falls in adults with transfemoral amputations (above the knee). The retrospective study found the average direct medical costs of adults without high tech prostheses hospitalized after falls were significantly greater than the average costs for adults with high tech prostheses who went to the emergency department. Part of the backstory in the study was that adults who did not have more advanced prostheses were less confident of their ability to move around, so they remained stationary most of the time. Because they didn’t get have benefits of exercise and the improved quality of life afforded by the added mobility of the microprocessor-controlled knees, they tended to have more severe injuries when they fell, which in turn resulted in greater direct medical expenses.
The Mayo Clinic researchers hope their study adds to change in the prosthesis approval decision process. “We want to help provide the best quality of life and prosthesis for each individual,” says Benjamin Mundell, Ph.D., the study’s lead author. Mundell, a medical study who is also a health economist further stated, “It is important to look beyond the initial cost differences of a microprocessor knee compared to a mechanical knee and understand what downstream costs might be avoided with a better prosthesis.”