Table 21:

Health State Costs—Other Health States

Variable	Unit Cost, $	Duration/Quantity	Total Cost, $	Standard Errora	Reference
Osseointegrated prosthesis
Yearly physiatrist check-up	74	1	74		SoB A313
Implant extraction
Professional feesb
Surgical	1,304	NA	1,304		SoB R241
Assistant	12	8 BU & 12 TU	241		SoB R241
Anesthesia	15	15 BU & 14 TU	435		SoB R241
Inpatient stay	14,979	7.7 days	14,979	413	OCCI – CMG 317
Reimplant
Device cost
Internal OGAP-OPLc	21,500	1	21,500		Montreal surgeryd
External OGAP-OPLe	11,000–15,000	1	15,000		Montreal surgeryd
Professional fees
Surgery
Surgical	1,304	NA	1,304		SoB R241
Assistant	12	8 BU & 12 TU	241		SoB R241
Anesthesia	15	15 BU & 14 TU	435		SoB R241
Postsurgery, surgeon consultation	43	1	43		SoB A063
Rehabilitation
Medical reassessment	65	1	65		SoB C314
Team management	39	14	546		SoB H312
Rehab counsel	77	2	154		SoB H313
Case conference	31	2	62		SoB K121
Discharge summary	59	1	59		SoB C124
Inpatient stayf	32,477	NA	24,357	2,326	Assume 25% reduction from initial implant surgery
Prosthetic fittingg
Fitting of definitive limb	$183.29/hour	10 hours	1,030		Assume 25% reduction from initial implant surgery
Outpatient care
Physiotherapy	$312 per episode of care	1	312		Ministry of Health and Long-Term Careh
Surgeon follow-up	24	2	48		SoB A064
Yearly physiatrist follow-up	74	1	74		SoB A313
Uncomfortable socket prosthesis
Yearly physiatrist check-up	74	1	74		SoB A313
Physiatrist visit for complication	71	4	142		SoB A311

Abbreviations: BU, basic units; CMG, case mix group; CT, computed tomography; NA, not applicable; OGAP-OPL, The Osseointegration Group of Australia Osseointegration Prosthetic Limb; OCCI, Ontario Case Costing Initiative; Rehab, rehabilitation; SoB, Ontario Physician Schedule of Benefits; TU, time units.

^aGamma distributions were used in the probabilistic reference case analysis using both the mean and standard error. In cases where a standard error is not provided, the values were assumed to be fixed.

^bBasic and time units were multiplied by either the anesthesiologist unit fee ($15.01) or the assistant fee ($12.04) to calculate total cost.

Table 21 notes continued on the next page.

Table 21 notes continued from the previous page.

^cIndicates internal components of the system, including the implant and dual cone.

^dNatalie Habra, MD, email communication, June 8, 2018.

^eIndicates external components of the system, including the taper sleeve, screw, bushing, and connector.

^fDerived from the Ontario Case Costing Initiative, using inpatient records from the Ottawa Hospital, a hospital with a specialized musculoskeletal rehabilitation program that provides inpatient beds to amputees. This stay includes both a patient's postoperative and rehabilitation stay.

^gAs this analysis took the perspective of the Ministry of Health and Long-Term Care, total costs assumed only 75% coverage through the Assistive Device Program, the current cost to the ministry.

^hMinistry of Health and Long-Term Care, Clinic-based physiotherapy [Internet]. Cited July 2, 2018 from: http://www.health.gov.on.ca/en/pro/programs/physio/physio_pro_doctors_nurses.aspx

Fee codes (in order of appearance in table):

SoB A313: Medical specific assessment (physical medicine and rehabilitation)

SoB R241: Revision total arthroplasty hip, one or both components (acetabular or femoral)

CMG 317: Revised hip replacement without infection

SoB A063: Specific assessment (orthopedic surgery's general listings)

SoB C314: Medical specific reassessment (physical medicine and rehabilitation)

SoB H312: Team management in a rehabilitation unit (first 12 weeks)

SoB H313: Rehabilitation counselling (physical medicine and rehabilitation)

SoB K121: Hospital inpatient case conference (family practice and practice in general)

SoB C124: Subsequent visits by the most responsible physician (day of discharge)

SoB A604: Partial assessment (orthopedic surgery's general listings)

SoB: A311: Complex medical specific reassessment