{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T23:14:11Z","timestamp":1766013251259,"version":"build-2065373602"},"reference-count":54,"publisher":"University of Toronto Libraries - UOTL","issue":"2","license":[{"start":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T00:00:00Z","timestamp":1761782400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Can. Prosthet. Orthot. J."],"abstract":"<jats:p>BACKGROUND: Use of a microprocessor-controlled knee (MPK) compared to a non-microprocessor-controlled knee (NMPK) can lead to improved walking ability, confidence and satisfaction. However, the MPK is more expensive than the NMPK and it is unknown whether the higher costs outweigh the potential benefits.\nOBJECTIVE:\u00a0To evaluate the cost-utility and cost-effectiveness of MPKs and NMPKs from a societal perspective in the Netherlands.\nMETHODOLOGY: Participants completed the Dutch version of the EuroQol - five dimensions - five levels (EQ-5D-5L) to assess health-related quality of life, three subscales (ambulation, utility and well-being) of the Prosthesis Evaluation Questionnaire (PEQ) to assess prosthesis-related quality of life and a cost-questionnaire from societal perspective. Incremental cost-utility ratio (ICUR) and incremental cost-effectiveness ratio (ICER) were calculated and the ICUR was compared with the Dutch willingness-to-pay threshold. Bootstrapping was used to estimate statistical uncertainty, and multiple imputation was applied to account for missing values.\nFINDINGS: In total, 111 participants were included (37 female, 73 male, 1 unknown; 71 transfemoral, 39 knee disarticulation, 1 unknown; age 64 \u00b1 13 years; 49 NMPK users, 62 MPK users). The cost-utility analysis demonstrated that the MPK yielded an increase of 0.032 quality adjusted life years (QALY) but at considerably higher costs. The mean cost difference was \u20ac 14,626, resulting in a mean ICUR of \u20ac 457,063 per QALY gained. The cost difference was mainly driven by acquisition costs but was partially compensated by lower costs of work absence, health care consumption and household care.\nCONCLUSION: The cost-effectiveness analyses demonstrated that the MPK is likely to provide benefits in term of prosthesis-specific quality of life, but at higher costs. However, short-term improvement in health-related quality of life was too small to result in substantial QALY gain to offset the higher costs of the MPK and result in an incremental cost-utility ratio below the generally accepted willingness-to-pay thresholds.\nLayman's Abstract\nIn this study, we compared two types of prosthetic knees that are used by people with a lower limb amputation. One is a high-tech version that uses a built-in computer sensor to help control movement (called a microprocessor controlled knee or MPK) and the other is a simpler, mechanical version (called a non-microprocessor controlled knee or NMPK). MPKs can help people walk more easily and feel more confident, but have a much higher acquisition cost. We compared the costs and benefits of both types of knees by studying 111 people who were either using an MPK or NMPK in their daily life. They completed surveys about their health, how they felt about their prosthesis, their healthcare use and work. Results showed that the people using an MPK reported better experiences in terms of mobility and satisfaction with their prosthesis. However, while the MPK did also improve quality of life a little bit, the improvement was small compared to how much more it costs. While the MPK helped reduce some other costs like time of work and healthcare use, the overall benefit wasn\u2019t enough to make it cost-effective by current standards in the Netherlands. In conclusion, while the MPK offers some advantages, they may not be enough to justify the higher price, at least not in the short term. More research could help us understand whether the benefits grow over time.\nArticle PDF Link: https:\/\/jps.library.utoronto.ca\/index.php\/cpoj\/article\/view\/45823\/34424\nHow To Cite: Bosman C.E, van der Sluis C.K, Vrieling A.H, Geertzen J.H.B, Seves B.L, Groen H. Health economic evaluation of microprocessor and non-microprocessor controlled prosthetic knees. Canadian Prosthetics &amp; Orthotics Journal. 2025; Volume 8, Issue 2, No. 3. https:\/\/doi.org\/10.33137\/cpoj.v8i2.45823\nCorresponding Author:\u00a0Charlotte E. Bosman, PhDAffiliation: Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.E-Mail: c.e.bosman@umcg.nlORCID ID: https:\/\/orcid.org\/0000-0001-7950-5893<\/jats:p>","DOI":"10.33137\/cpoj.v8i2.45823","type":"journal-article","created":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T23:44:13Z","timestamp":1761867853000},"source":"Crossref","is-referenced-by-count":2,"title":["HEALTH ECONOMIC EVALUATION OF MICROPROCESSOR AND NON-MICROPROCESSOR CONTROLLED PROSTHETIC KNEES"],"prefix":"10.33137","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7950-5893","authenticated-orcid":false,"given":"Charlotte E.","family":"Bosman","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2141-8214","authenticated-orcid":false,"given":"Corry K.","family":"Van der Sluis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aline H.","family":"Vrieling","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4719-0887","authenticated-orcid":false,"given":"Jan H.B.","family":"Geertzen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4066-1893","authenticated-orcid":false,"given":"Bregje L.","family":"Seves","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6629-318X","authenticated-orcid":false,"given":"Henk","family":"Groen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"18618","published-online":{"date-parts":[[2025,10,30]]},"reference":[{"key":"108528","doi-asserted-by":"crossref","unstructured":"1.Couture M, Caron CD, Desrosiers J. Leisure activities following a lower limb amputation. Disabil Rehabil. 2010; 32(1): p. 57\u201364. https:\/\/doi.org\/10.3109\/09638280902998797","DOI":"10.3109\/09638280902998797"},{"key":"108529","doi-asserted-by":"crossref","unstructured":"2.Gallagher P, O'Donovan MA, Doyle A, Desmond D. Environmental barriers, activity limitations and participation restrictions experienced by people with major limb amputation. Prosthet Orthot Int. 2011; 35(3): p. 278\u201384. https:\/\/doi.org\/10.1177\/0309364611407108","DOI":"10.1177\/0309364611407108"},{"key":"108530","doi-asserted-by":"crossref","unstructured":"3.Whyte AS, Carroll LJ. A preliminary examination of the relationship between employment, pain and disability in an amputee population. Disabil Rehabil. 2002; 24(9): p. 462\u201370. https:\/\/doi.org\/10.1080\/09638280110105213","DOI":"10.1080\/09638280110105213"},{"key":"108531","unstructured":"4.Hafner BJ, Smith DG. Differences in function and safety between Medicare Functional Classification Level-2 and -3 transfemoral amputees and influence of prosthetic knee joint control. J Rehabil Res Dev. 2009; 46(3): p. 417\u201333. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/19675993\/"},{"key":"108532","doi-asserted-by":"crossref","unstructured":"5.Hahn A, Bueschges S, Prager M, Kannenberg A. The effect of microprocessor controlled exo-prosthetic knees on limited community ambulators: Systematic review and meta-analysis. Disabil Rehabil. 2022; 44(24): p. 7349\u201367. https:\/\/doi.org\/10.1080\/09638288.2021.1989504","DOI":"10.1080\/09638288.2021.1989504"},{"key":"108533","doi-asserted-by":"crossref","unstructured":"6.Hafner BJ, Willingham LL, Buell NC, Allyn KJ, Smith DG. Evaluation of function, performance, and preference as transfemoral amputees transition from mechanical to microprocessor control of the prosthetic knee. Arch Phys Med Rehabil. 2007; 88(2): p. 207\u201317. https:\/\/doi.org\/10.1016\/j.apmr.2006.10.030","DOI":"10.1016\/j.apmr.2006.10.030"},{"key":"108534","doi-asserted-by":"crossref","unstructured":"7.Kannenberg A, Zacharias B, Pr\u00f6bsting E. Benefits of microprocessor-controlled prosthetic knees to limited community ambulators: Systematic review. J Rehabil Res Dev. 2014; 51(10): p. 1469\u201396. https:\/\/doi.org\/10.1682\/JRRD.2014.05.0118","DOI":"10.1682\/JRRD.2014.05.0118"},{"key":"108535","doi-asserted-by":"crossref","unstructured":"8.Kahle JT, Highsmith MJ, Hubbard SL. Comparison of nonmicroprocessor knee mechanism versus C-Leg on Prosthesis Evaluation Questionnaire, stumbles, falls, walking tests, stair descent, and knee preference. 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Prosthesis. 2025; 7(4): p. 89. https:\/\/doi.org\/10.3390\/prosthesis7040089","DOI":"10.3390\/prosthesis7040089"},{"key":"108538","doi-asserted-by":"crossref","unstructured":"11.Lansade C, Vicaut E, Paysant J, M\u00e9nager D, Cristina MC, Braatz F, et al., Mobility and satisfaction with a microprocessor-controlled knee in moderately active amputees: A multi-centric randomized crossover trial. Ann Phys Rehabil Med. 2018; 61(5): p. 278\u201385. https:\/\/doi.org\/10.1016\/j.rehab.2018.04.003","DOI":"10.1016\/j.rehab.2018.04.003"},{"key":"108539","doi-asserted-by":"crossref","unstructured":"12.Theeven PJ, Hemmen B, Geers RP, Smeets RJ, Brink PR, Seelen HA. Influence of advanced prosthetic knee joints on perceived performance and everyday life activity level of low-functional persons with a transfemoral amputation or knee disarticulation. 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Disabil Rehabil. 2022;44(26):8471\u20139. https:\/\/doi.org\/10.1080\/09638288.2021.2015628","DOI":"10.1080\/09638288.2021.2015628"},{"key":"108565","doi-asserted-by":"crossref","unstructured":"38.Legro MW, Reiber GD, Smith DG, del Aguila M, Larsen J, Boone D. Prosthesis Evaluation Questionnaire for persons with lower limb amputations: assessing prosthesis-related quality of life. Arch Phys Med Rehabil. 1998;79(8):931\u20138. https:\/\/doi.org\/10.1016\/s0003-9993(98)90090-9","DOI":"10.1016\/S0003-9993(98)90090-9"},{"key":"108566","unstructured":"39.Prosthetics Research Study. Guide for the Use of the Prosthesis Evaluation Questionnaire [Internet]. 1998 [cited 2025 Aug 7]. Available from: http:\/\/analisedemarcha.com\/papers\/o_p\/peq\/EN\/peq-Evaluation_Guide.pdf"},{"key":"108567","doi-asserted-by":"crossref","unstructured":"40.Jakubiak-Lasocka J, Jakubczyk M. 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