scholarly journals HEALTH SERVICE DELIVERY AND ECONOMIC EVALUATION OF LIMB LOWER BONE-ANCHORED PROSTHESES: A SUMMARY OF THE QUEENSLAND ARTIFICIAL LIMB SERVICE’S EXPERIENCE

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Laurent Frossard ◽  
Debra Berg

The emergence of skeletal prosthetic attachments leaves governmental organizations facing the challenge of implementing equitable policies that support the provision of bone-anchored prostheses (BAPs). In 2013, the Queensland Artificial Limb Service (QALS) started a five-year research project focusing on health service delivery and economic evaluation of BAPs. This paper reflects on the QALS experience, particularly the lessons learned. QALS’ jurisdiction and drivers are presented first, followed by the impact of outcomes, barriers, and facilitators, as well as future developments of this work. The 21 publications produced during this project (e.g., reimbursement policy, role of prosthetists, continuous improvement procedure, quality of life, preliminary cost-utilities) were summarized. Literature on past, current, and upcoming developments of BAP was reviewed to discuss the practical implications of this work. A primary outcome of this project was a policy developed by QALS supporting up to 22 h of labor for the provision of BAP care. The indicative incremental cost-utility ratio for transfemoral and transtibial BAPs was approximately AUD$17,000 and AUD$12,000, respectively, per quality-adjusted life-year compared to socket prostheses. This project was challenged by 17 barriers (e.g., limited resources, inconsistency of care pathways, design of preliminary cost-utility analyses) but eased by 18 facilitators (e.g., action research plan, customized database, use of free repositories). In conclusion, we concluded that lower limb BAP might be an acceptable alternative to socket prostheses from an Australian government prosthetic care perspective. Hopefully, this work will inform promoters of prosthetic innovations committed to making bionic solutions widely accessible to a growing population of individuals suffering from limb loss worldwide. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/36210/28330 How To Cite: Berg D, Frossard L. Health service delivery and economic evaluation of limb lower bone-anchored prostheses: A summary of the Queensland artificial limb service’s experience. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, No.12. https://doi.org/10.33137/cpoj.v4i2.36210 Corresponding Author: Laurent Frossard, PhD, Professor of BionicsYourResearchProject Pty Ltd, Brisbane, Australia.E-Mail: [email protected] number: https://orcid.org/0000-0002-0248-9589

2004 ◽  
Vol 3 (1) ◽  
pp. 91-108 ◽  
Author(s):  
Christine Murray

AbstractThe impact of globalization on health is complex, both positively and negatively. Benefits include improved medical technology and services, but globalization also has promoted patterns of dependency, development, settlement, and lifestyles that have been detrimental to health. This paper draws examples from the small island nations of the Pacific to show how globalization impacts environmental health, health service delivery, and lifestyles. It shows that, paradoxically, in the smallest and most remote nations the negative impacts of globalization are felt most strongly in urban areas where living standards might appear to be highest.


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