Health care costs of major upper-extremity amputations in Ontario: a retrospective matched-cohort analysis with considerations for transplantation.

Abstract

Background: Major upper-extremity amputation, defined as loss above the wrist, profoundly affects all aspects of life and imposes substantial health care burdens. Standard care involves prosthetics, which have limitations, while vascularized composite allotransplantation (VCA) offers improved functionality but raises cost-effectiveness concerns. We sought to evaluate health care use and cost of major upper-extremity amputation in Ontario.

Methods: We conducted a 20-year retrospective matched-cohort study using administrative health care data from Ontario. We matched patients with major upper-extremity amputations (April 2002 to March 2023) 4:1 with general population and hospital-based trauma controls. We analyzed health care use and costs by follow-up duration (1 yr, 1 to 4 yr, 5 to 9 yr, > 10 yr).

Results: We identified 617 patients with a mean follow-up of 6.95 years, including 41.7% with traumatic amputations and 58.3% with nontraumatic amputations. Forearm-level amputations were most common. Median health care costs were $52 661 (interquartile range [IQR] $22 009 to $120 120) for traumatic amputations and $90 928 (IQR $43 128 to $213 034) for nontraumatic amputations, both exceeding controls. Bilateral amputations incurred higher costs than unilateral amputations ($104 895 [IQR $41 290 to $243 967] for traumatic and $117 006 [IQR $68 447 to $226 491] for nontraumatic cases), excluding prosthetics. Total treatment costs with myoelectric prosthetics exceeded $344 895 for patients with bilateral amputations and $171 860 for those unilateral amputations, surpassing prior projections.

Conclusion: Although lifetime VCA costs remain higher than for prosthetics, the lack of Canadian utility measures, societal cost data, and return-to-work outcomes underscores the need for further study to assess whether the functional and quality-of-life benefits could justify these expenditures for patients with bilateral amputations.