Objectives: Pediatric limb loss resulting from congenital deficiencies, cancer, or trauma often leads to significant physical, emotional, and financial stress to the child and family. Prosthetic devices provide an opportunity to optimize functional independence and improve psychological wellbeing. Despite benefits, the cost of such devices can be prohibitively high for many families. The purpose of this study was to estimate the prevalence of major lower limb (LL) loss, prosthetic use, and associated costs among children covered by commercial health insurance.
Design: The 2009-2015 MarketScan®Database was used to identify children (< 18 years) with major LL loss in the US. Diagnosis and procedure codes were used to classify LL etiology for patients with at least one claim for a missing LL or LL amputation. L-codes were used to identify prosthesis-related visits and associated costs, based on insurance payments to providers.
Results: We identified 13,997 children with major LL during the study period, yielding a prevalence of 9.8 per 100,000 privately insured children (in 2009). Congenital deficiencies accounted for 83% of all pediatric LL cases, followed by 13.5% from trauma. At the time of their first LL-related claim, about half were male (50.7%) and the majority were covered by a PPO (63%). The most common age at initial claim was 10-14 years (39.0%) and the south was the most common region (31.3%). The average annual number of prosthetic-related visits was 5.1 (SD=5) with an associated annual average cost of $4,156 (SD=$4,532). Annual costs varied significantly by etiology, level and plan type.
Conclusions: Providing a child or adolescent with a comfortable prosthesis as they grow means regular need for prosthetic services and new sockets. This can result in significant financial burden to most families. Alternatives to existing devices ― adjustable sockets that accommodate limb growth― might reduce annual and lifetime costs for pediatric prosthetic users.
Mitra McLarney– Resident Physician, University of Pennsylvania
Emily McGinley– Biostatistician, Medical College of Wisconsin
Liliana Pezzin– Professor of Economics and Health Policy, Medical College of Wisconsin
Laura Prosser– Research Scientist, Children's Hospital of Pennsylvania
Timothy Dillingham– The William J. Erdman II, Professor and Chair, University of Pennsylvania