ArticleCanadian prosthetics & orthotics journal2026
Cost-effectiveness of microprocessor-controlled prosthetic knees in the Dutch healthcare system: The impact of study duration on outcomes.
Article in Canadian prosthetics & orthotics journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Abstract
A previous health-utility analysis of microprocessor-controlled prosthetic knees (MPKs) in the Netherlands used a very short evaluation period of only 6 months resulting in an extremely high incremental cost-utility ratio (ICUR) of €457,063 per quality-adjusted life year (QALY) gained. However, for proper health-economic analyses, an appropriate time horizon, usually the useful life of an intervention, must be chosen to avoid biased results. Therefore, we performed a basic cost-utility analysis (CUA) extrapolating and properly discounting the utility and cost data reported by that article over the useful lifetime of MPKs of 6 years and found an ICUR of €17,945 per QALY. To further refine the CUA, we conducted a modeling study of the ICUR of the MPKs over a timeframe from 6 months to 25 years using existing and published population models for Germany and Sweden. In the modeling study, the ICUR was higher for the Netherlands with €37,567 per QALY than for Germany (€18,276 per QALY) or Sweden (€11,147 per QALY) but below the Dutch threshold for willingness to pay of €50,000 per QALY for people with a lower-limb amputation. Thus, the MPKs were cost-effective for the Dutch healthcare system in all scenarios of the cost-utility analysis. Our analysis showed that time had a much bigger impact on the ICUR than utility with the MPKs becoming cost-effective with the ICUR falling below the €50,000-per-QALY threshold after 4-5 years of use. Thus, a proper time horizon covering the useful lifetime of an intervention is key for health-economic analyses to prevent potentially misleading results and unjustified detrimental decisions for patients.
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