A Cost-Benefit Analysis of 160 Patients With Electrically Powered Limbs

W. F. SAUTER, CPO(C)*Toronto, Ontario


The undertaking was intended to provide a clearer picture of the costs associated with the provision and maintenance of electrically powered upper-extremity prostheses to the members of amputee rehabilitation teams.

At the Ontario Crippled Children's Centre, the files of 160 men, women and children, with a continuous record dating from 1973-1983, were investigated to obtain a profile, not only for purchasing and maintenance costs, but also to assess the contributions of different components to the costs. The findings are expressed in actual dollars; no attempt has been made to relate the findings to indices of inflation. Since the costs have been sampled over a 10-year period, today's prices are obviously considerably higher.

Patient Group

Files of 110 adult patients and 50 children under 14 years were surveyed. The oldest patient was 60 and the youngest 2.5 years. The entire group is composed of:

124 below-elbow amputees

2 bilateral below-elbow amputees

18 above-elbow amputees

13 shoulder-disarticulation amputees

2 bilateral amelics

I phocomelic

Accumulated wearing time was 615 years or 3.9 years per patient. Patients averaged 3.14 visits per year. The average initial cost per patient was $3,954 Canadian.

The annual maintenance cost per patient is $500.79.

Analysis of Children's Fittings

50 patients were surveyed; 58 limbs supplied.
Ages ranged from 2.10-14 years (average: 7.6 years)
Years of accumulated prosthetic use: 138
Average duration of use: 2.8 years
Average cost of limbs: $3,665.00
Maintenance cost per year: $746.81

The most expensive prosthesis was provided to a 14-year-old boy; repairs cost $198.00 each month for 34 months. The most economical fitting was for a 14-year-old girl; $7.97 was spent per month for 40 months. The group of 50 juvenile patients required 237 gloves costing $90 each, a total of $21,330. The expense amounts to $154 for gloves per patient year, equal to 1.7 gloves per patient year.

Benefits

Electrically powered prostheses, compared with conventional limbs, offer much improved appearance Improved patient self-image and self-esteem Improved social acceptance No teasing from peers Freedom from any harness Much improved function of high-level amputees 90 per cent acceptance rate Patients stay enrolled in prosthetic programs Better job prospects.

Conclusions

The average maintenance costs per patient experienced in an institutional facility operating under a cost-recovery scheme suggest that the benefits of electrically powered (switched or myoelectric) prostheses justify the initial costs and maintenance expenditures incurred.

Costs are comparable to maintenance costs for conventional upper-extremity devices paid out by the Workmen's Compensation Board of Ontario**.

*Powered Upper Extremity Prosthetic Service Program, Rehabilitation Engineering Department, Ontario Crippled Children's Centre, 350 Rumsey Road, Toronto, Ontario, M4G 1R8 Canada

**Verbal communication with Bill Burt, CPO(C) WCB Hospital, Torbarrie Road Downsview, Ontario