Journal of NeuroEngineering and Rehabilitation

RESEARCH Open Access Economic value of orthotic and prosthetic services among medicare beneficiaries: a claims-based retrospective cohort study, 2011 – 2014 Allen Dobson, Kennan Murray * , Nikolay Manolov and Joan E. DaVanzo From Second World Congress hosted by the American Orthotic & Prosthetic Association (AOPA) Las Vegas, NV, USA. 06-09 September 2017 Abstract Background: There are few studies of the economic value of orthotic and prosthetic services. A prior cohort study of orthotic and prosthetic Medicare beneficiaries based on Medicare Parts A and B claims from 2007 to 2010 concluded that patients who received timely orthotic or prosthetic care had comparable or lower total health care costs than a comparison group of untreated patients. This follow-up study reports on a parallel analysis based on Medicare claims from 2011 to 2014 and includes Part D in addition to Parts A and B services and expenditures. Its purpose is to validate earlier findings on the extent to which Medicare patients who received select orthotic and prosthetic services had less health care utilization, lower Medicare payments, and potentially fewer negative outcomes compared to matched patients not receiving these services. Methods: This is a retrospective cohort analysis of 78,707 matched pairs of Medicare beneficiaries with clinical need for orthotic and prosthetic services ( N = 157,414) using 2011 – 2014 Medicare claims data. It uses propensity score matching techniques to control for observable selection bias. Economically, a cost-consequence evaluation over a four-year time horizon was performed. Results: Patients who received lower extremity orthotics had 18-month episode costs that were $1939 lower than comparable patients who did not receive orthotic treatment ($22,734 vs $24,673). Patients who received spinal orthotic treatment had 18-month episode costs that were $2094 lower than comparable non-treated patients ($23,560 vs $25,655). Study group beneficiaries receiving both types of orthotics had significantly lower Part D spending than those not receiving treatment ( p < 0.05). Patients who received lower extremity prostheses had comparable 15-month episode payments to matched beneficiaries not receiving prostheses ($68,877 vs $68,893) despite the relatively high cost of the prosthesis. Conclusions: These results were consistent with those found in the prior study and suggest that orthotic and prosthetic services provide value to the Medicare program and to the patient. Keywords: Amputation, Cost-effectiveness, Limb-loss, Medicare, Orthoses, Prostheses, Rehabilitation * Correspondence: kennan.murray@dobsondavanzo.com Dobson DaVanzo & Associates, LLC, 450 Maple Avenue East, Suite 303, Vienna, VA 22180, USA © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ) , which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated. Dobson et al. Journal of NeuroEngineering and Rehabilitation 2018, 15 (Suppl 1):55 https://doi.org/10.1186/s12984-018-0406-7