A review of utilities and costs of treating upper extremity amputations with vascularized composite allotransplantation versus myoelectric prostheses in Canada.

Background: Hand vascularized composite allotransplantation (VCA) and myoelectric prostheses have proven their efficacy for treating hand amputation. Despite reported functional outcomes, the lack of consensus on VCA versus myoelectric prostheses brought us to report on their utilities and costs within the Canadian healthcare system. Methods: A review of utility outcomes and costs was performed for VCA and myoelectric prostheses and a comparison between unilateral versus bilateral amputations was made. Results: The simulation model demonstrated that significant savings could be achieved with both hand transplantation ($10.04 billion) and myoelectric prostheses ($12.17 billion) in all Canadian patients sustaining hand amputation with a 30-year life expectancy., Myoelectric prosthesis had lowest total cost compared to hand VCA by generating savings of $4,458,445,840 and $1,868,121,840 when compared to bilateral and unilateral upper limb amputations respectively. Conclusion: Treatment of unilateral amputations with myoelectric prostheses would cost significantly less to the society, whereas the gap in cost savings becomes less significant in bilateral amputees. From the socioeconomic standpoint of the Canadian healthcare system, this simulation model demonstrates that significant savings can be achieved with both treatments.