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IN ELDERLY PATIENTS WITH LOWER LIMB AMPUTATIONS. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, ORAL PRESENTATION AT THE 
AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018.DOI: https://doi.org/10.33137/cpoj.v1i2.32041                                                                

 

1 

 
OPEN  ACCESS 

 

AOPA’S 101 ST NATIONAL ASSEMBLY ABSTRACTS, SEPTEMBER 26-29, VANCOUVER, CANADA, 2018 
 

ABSTRACT (ORAL PRESENTATION) 

INFLUENCE OF FALLS REDUCTION ON THE COST-EFFECTIVENESS OF 

ADVANCED HYDRAULIC MICROPROCESSOR CONTROLLED KNEE PROTHESES 

IN ELDERLY PATIENTS WITH LOWER LIMB AMPUTATIONS 

Henning Krüger1, Andreas Hahn*2, Alexander Kuhlmann3 

1 Leibniz University Hanover, Germany. 
2 Otto Bock HealthCare, Vienna, Austria. 
3 Center for Health Economics Research Hannover (CHERH), Hanover, Germany. 

* E-Mail: andreas.hahn@ottobock.com 

DOI: https://doi.org/10.33137/cpoj.v1i2.32041  

 

INTRODUCTION 

The assessment of cost-effectiveness and the use of 

health economical methods becomes of increasing 

importance when evaluating the impact of modern 

medical technology. The cost effectiveness of advanced 

hydraulic microprocessor controlled knees (MPKs) had 

recently by shown by RAND 1. A new generation of 

advanced hydraulic microprocessor controlled knee 

(MPK) components became available to address 

specifically the needs of elderly individuals The 

reduction of concomitant factors such as falls may 

significantly improve cost-effectiveness.  

OBJECTIVE 

Aim of this investigation is to assess the cost 

effectiveness of advanced hydraulic MPKs vs. non- 

MPKs in a population of elderly above-knee amputees. 

METHODS 

A health economical decision tree based model was 

developed on the basis of existing clinical results 2,3. The 

model population (n=1.000, transfemoral amputees, no 

gender specification) is of either vascular or non-vascular 

etiology and aged between 55 and 75 years. The 

incremental cost-effectiveness (ICER) is calculated to 

assess the economic efficiency of advanced hydraulic 

MPKs. Depending on the etiology and the chosen 

prosthetic fitting, the risk of falls, the number of falls, the 

severity of injuries and the injury related mortality are 

modeled over a five years horizon. Parameters related to 

costs and quality of live assessments are taken from the 

literature. To verify model assumptions and uncertainties 

in the chosen parameters a univariate analysis of the 

sensitivity is performed 4.  

 

 

RESULTS 

The comparison of MPK and non-MPKs yields an ICER 

of 16.910 $ per QALY for vascular and 19.848 $ per 

QALY for non-vascular etiology. The largest impact on 

the model is due to the health utility values and prosthetic 

costs. The fatality avoidance rate is 7 fold increased in 

the vascular population. 

 

Figure 1. Comparison of ICER findings for elderly with 

RAND Results. 

 

CONCLUSION 

Results of the analysis indicate the cost-effectiveness 

of advanced hydraulic MPKs in elderly patients with 

lower limb amputation. We highlight the specific 

advantages fur subjects with vascular disease.  

SIGNIFICANCE 

Cost effectiveness of advanced hydraulic MPKs could 

also be shown in the population of elderly transfemoral 

amputees. Such findings may be supportive when 

https://doi.org/10.33137/cpoj.v1i2.32041
mailto:andreas.hahn@ottobock.com
https://doi.org/10.33137/cpoj.v1i2.32041


 

 

Krüger H, Hahn A, Kuhlmann A. INFLUENCE OF FALLS REDUCTION ON THE COST-EFFECTIVENESS OF ADVANCED HYDRAULIC MICROPROCESSOR CONTROLLED KNEE PROTHESES 
IN ELDERLY PATIENTS WITH LOWER LIMB AMPUTATIONS. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, ORAL PRESENTATION AT THE 
AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018.DOI: https://doi.org/10.33137/cpoj.v1i2.32041                                                                

 

2 

 
OPEN  ACCESS 

 

AOPA’S 101 ST NATIONAL ASSEMBLY ABSTRACTS, SEPTEMBER 26-29, VANCOUVER, CANADA, 2018 
 

ABSTRACT (ORAL PRESENTATION) 

arguing for successful coverage. Further need for 

research was identified.  

REFERENCES 

1. Liu et al., Economic Value of Advanced Transfemoral 

Prosthetics. Santa Monica, CA: RAND Corporation, 2017. 

https://www.rand.org/pubs/research_reports/RR2096.html. 

2. Gerzeli S,Torbica A, Fattore G. Cost utility analysis of knee 

prosthesis with complete microprocessor control (C-leg) 

compared with mechanical technology in trans-femoral 

amputees. Eur J Health Econ. 2009 Feb;10(1):47-55. doi: 

10.1007/s10198-008-0102-9. Epub 2008 Apr 1. 

3. Seelen etal. Costs and consequences of a prosthesis with an 

electronically stance and swing phase controlled knee joint. 

Technol Disabil 2009;21(1–2):25–34. DOI: 10.3233/TAD-

2009-0269 

4. Krüger, 2016, A Cost Estimation Model for the Extractive 

Software-Product-Line Approach. Master thesis, University of 

Magdeburg, Germany, February 2016. http://wwwiti.cs.uni-

magdeburg.de/iti_db/publikationen/ps/auto/thesisKrueger.pdf 

DISCLOSURE 

Krüger was M.Sc. of the Leibniz University Hanover. Hahn is 

full-time employee of Otto Bock HealthCare. Kuhlmann is 

Senior Research Associate at the CHERH of the University of 

Hanover. 

 

https://doi.org/10.33137/cpoj.v1i2.32041
http://wwwiti.cs.uni-magdeburg.de/iti_db/publikationen/ps/auto/thesisKrueger.pdf
http://wwwiti.cs.uni-magdeburg.de/iti_db/publikationen/ps/auto/thesisKrueger.pdf

