The prevalence of lower limb loss in children and associated costs of prosthetic devices: A national study of commercial insurance claims

Although the incidence of major pediatric lower limb loss secondary to either congenital deficiencies or acquired amputations is relatively low, the prevalence of lower limb loss among children in the United States (US) remains unknown.To estimate the prevalence of major lower limb loss, and the associated prosthetic services use and costs among commercially-insured children in the US.Observational, retrospective, longitudinal cohort study.The IBM MarketScan®Commercial Database was used to identify children (18 years) with major lower limb loss in the US between 2009 and 2015. Descriptive statistics were used to characterize pediatric cases according to sociodemographic and limb loss characteristics. Multivariate models assessed factors associated with annual prosthetic visits, prosthetic-related costs, and overall medical costs.Of the 36.5 million children in the MarketScan database, 14,038 had a major lower limb loss, yielding a prevalence estimate of 38.5 cases per 100,000 commercially insured children in the US during the 7-year study period. Congenital deficiencies accounted for 84% of cases, followed by 13.5% from trauma. Only 10.1% had at least one prosthesis-related visit during any 12-month period following their cohort entry. Among those, the mean annual prosthetic-related costs ranged from $50 to $29,112 with a median annual cost of $2778 (interquartile range = $4567). Annual coinsurance and copays for prosthetic services accounted for nearly half of the overall annual out-of-pocket outlays with medical care for these children.Pediatric lower limb loss results in lifelong prosthetic needs. This study informs insurers and policy-makers regarding the prevalence of these patients and the medical costs for their care.