Introduction
Prosthetic care has traditionally been viewed as a healthcare cost, often neglecting the significant social and economic advantages that early intervention can offer. By shifting the perspective to see prosthetic care as an investment, it becomes clear that fast-fitting prosthetics and mobile amputee support units can yield a much higher return on investment (ROI) than conventional methods. These benefits extend beyond direct medical costs to include societal impacts such as economic productivity, social integration, and long-term healthcare savings.
This brief explores the economic rationale for early prosthetic intervention, highlighting solutions that are feasible, sustainable, and scalable. Using principles of health economics, it demonstrates how early intervention enhances outcomes for patients and society while fulfilling the rehabilitation service standards set by the World Health Organization (WHO).
The Economic Case for Early Intervention
Early intervention in prosthetic care, supported by innovations like fast-fitting prosthetics and community-based prosthetic services, aligns with the economic principles of efficiency and long-term value. Modern fast-fitting prosthetics using mouldable sockets can fit residual limbs in an hour, compared to traditional plaster-casting methods that take many hours and require multiple adjustments. Although the initial costs of newer technologies may be higher, the long-term benefits have the potential to outweigh these capital expenses.
Direct Costs and Efficiency
Early intervention in amputee support, facilitated by innovative, fast-fitting solutions that allow fitting immediately after wound heal, has the potential to dramatically reduce the time and resources typically needed for prosthetic fitting. A traditional prosthetic fitting process typically requires 5-7 clinic visits over several weeks, whereas new fast-fitting solutions can complete the process in a single day, allowing one clinician to serve up to 5-10 patients a day, reducing the time and cost involved. This efficiency lowers clinical overheads and increases patient throughput, providing more timely care.
In addition, models of community-based access that bring care directly to patients further optimize efficiency. Providing care through mobile units that are located within communities reduce transportation costs and logistical challenges. This is especially pertinent in resource-limited or conflict-affected regions where access to static healthcare centres may very limited. By decentralizing care, mobile units can extend their reach to underserved populations while maintaining cost-effectiveness.
External Benefits and ROI
Early intervention offers substantial external benefits, presenting a compelling case for a high return on investment:
Economic productivity: Restoring mobility through timely prosthetic care enables individuals to return to work, reducing dependence on external support and fostering self-sufficiency. For child amputees, early access to prosthetics leads to quicker school reintegration, enhancing educational outcomes and future workforce participation. This is particularly important in conflict zones, where rapid growth and frequent refitting challenges can complicate care. Consider the case of Yazan, a young boy who had lost three limbs. In a world first he was fitted with prosthetics and took his first step within 24 hours during an evaluation of fast-fitting technology in Amman, Jordan. You can read about his story here: https://www.lsngroup.org/post/walking-in-24-hrs-world-s-first-rapid-fitting-of-a-triple-amputee-from-gaza-with-both-upper-and-low.
Social integration: Mobility enhances independence and community participation, promoting resilience and strengthening social networks. This contributes to societal stability and reduces the long-term strain on caregivers.
Healthcare savings: Early intervention prevents secondary health complications such as joint stiffness, obesity, and mental health issues that often arise from delayed care. This lowers future healthcare costs and enhances system efficiency.
Family stability: Effective prosthetic care eases the caregiving burden, allowing families to regain financial and emotional stability, which improves resilience and reduces long-term societal costs.
Educational attainment: For children, timely access to prosthetics reduces educational disruptions, ensuring better cognitive development and long-term success. Imagine a child amputee waiting six months for a prosthetic limb - that's six months of missed schooling, delayed development, and social isolation. Now imagine that same child receiving a properly fitted prosthetic within weeks of their injury, quickly returning to childhood activities.
Environmental benefits: Resource-efficient, recyclable materials used in fast-fitting prosthetics align with sustainability goals, reducing environmental impact and supporting long-term resource conservation.
Several findings from related research areas ([1],[2],[3]) suggest that early intervention protocols, despite being costlier at the outset, result in significant savings and improved outcomes over time due to reductions in long-term healthcare needs and enhanced patient productivity.
Clinical and Mental Health Outcomes
Fast-fitting prosthetics not only enhance clinical outcomes but also improve mental health, especially when interventions occur soon after injury:
Improved Injury Outcomes: Early mobility reduces complications such as muscle atrophy and joint stiffness, leading to better long-term recovery.
Mental Health Benefits: Early prosthetic care can alleviate the psychological impact of amputation, such as depression and anxiety. This is crucial for both adults and children, as delays in care can disrupt emotional and social development.
Independence and Productivity: By regaining mobility, amputees can lead more independent lives, contributing to their families and communities, reducing long-term dependency, and improving overall quality of life. In conflict-affected areas, such as Gaza, the ability to walk, cycle or carry items means that person can move to a place of safety, help their family collect water, or queue for food.
Challenges and Solutions in Conflict-Affected Areas
Conflict zones present unique challenges to prosthetic care, such as limited infrastructure, resource constraints, and high patient volumes. Early intervention through mobile units and fast-fitting prosthetics addresses these challenges by:
Increasing accessibility: Mobile units bring care to remote or conflict-affected areas, ensuring timely care despite infrastructural limitations.
Reducing overheads: By decentralizing care, mobile units lower operational costs, making healthcare systems more sustainable in resource-limited settings.
Enhancing scalability: Fast-fitting prosthetics allow for quicker patient turnover, enabling healthcare systems to handle higher patient volumes more efficiently.
Aligning with WHO Minimum Rehabilitation Service Requirements
The WHO Minimum Rehabilitation Service Requirements highlight the importance of early intervention in prosthetic care, especially in vulnerable and conflict-affected populations. By integrating fast-fitting prosthetics with community-based delivery models, an early-intervention approach supports key WHO recommendations, as follows:
1. Inclusive access to rehabilitation for vulnerable populations
WHO prioritizes vulnerable groups, such as people with disabilities, children, and older adults, for rehabilitation services. Early intervention through fast-fitting prosthetics ensures that these populations, especially those in underserved areas or conflict zones, can receive timely and equitable care. Mobile prosthetic units bring services directly to remote populations and displaced individuals, ensuring inclusive access in challenging environments.
This model also ensures that children and individuals with specific needs receive age-appropriate and disability-specific care early in their recovery, addressing the WHO's call for accessible rehabilitation for all.
2. Community-based rehabilitation (CBR) and outreach
The WHO emphasizes the importance of Community-Based Rehabilitation (CBR), recommending outreach through mobile clinics and home visits. The community-based delivery model of fast-fitting prosthetics is well-suited to reach individuals in temporary shelters, conflict settings, and other inaccessible areas. By bringing services directly to individuals, these units ensure that even those with limited mobility or in displaced settings receive immediate and ongoing care. This aligns with WHO’s goal of reaching vulnerable populations through outreach and community-based approaches.
3. Comprehensive and integrated care
WHO calls for the integration of rehabilitation services across primary, secondary, and tertiary care levels. Early intervention with fast-fitting prosthetics can be seamlessly integrated into comprehensive rehabilitation plans, including physical therapy, psychosocial support, and mental health services. Community-based prosthetic services ensure coordination between care providers, facilitating both acute recovery and long-term support. This integrated approach ensures continuity of care, which is vital for achieving the best rehabilitation outcomes.
4. Mental health and psychosocial support (MHPSS)
WHO highlights the need for Mental Health and Psychosocial Support (MHPSS), particularly for conflict-affected populations. Early intervention in prosthetic care should be accompanied by psychosocial support, addressing both the physical and emotional needs of individuals affected by trauma or disability. The mobile prosthetic model can integrate psychosocial care into outreach, ensuring that trauma-informed care is provided alongside the physical rehabilitation services. This aligns with WHO’s recommendation to offer holistic, psychosocial support alongside rehabilitation.
5. Health education and promotion
The WHO underscores the importance of health education and promotion in rehabilitation. Early intervention models of prosthetic care should be paired with education programs that empower individuals and caregivers with the knowledge to use assistive devices effectively. Community-based delivery models offer a unique opportunity to educate communities on managing chronic conditions, preventing further injury, and optimizing the use of prosthetics. This ensures that individuals are not only receiving care but are also equipped with the tools and knowledge to maintain long-term functional independence.
6. Sustainable and long-term rehabilitation
According to WHO, rehabilitation must transition from acute care to addressing long-term needs after the emergency phase. Fast-fitting prosthetics play a critical role in ensuring that individuals have immediate access to functional limbs, but the sustainability of this care model also supports long-term rehabilitation. By providing efficient, cost-effective prosthetics in a community-based delivery model, individuals can receive timely replacements, adjustments, and follow-up care, thus promoting functional independence and community reintegration in the long term. This model supports the transition from emergency response to sustained rehabilitation, as emphasized by WHO.
Conclusion
Early intervention in prosthetic care represents a transformative shift from viewing prosthetics as a cost to recognizing them as an investment. Fast-fitting prosthetics and mobile support units can improve clinical and mental health outcomes while delivering significant social and economic benefits. Prioritizing early intervention can lead to higher ROI, reduced long-term costs, and improved quality of life for amputees.
This approach is particularly vital in conflict-affected areas, where traditional healthcare models often fail to meet the needs of vulnerable populations. By aligning with WHO guidelines and leveraging health economics principles, early intervention to amputee support offers a feasible, sustainable, and scalable solution that benefits both individuals and society as a whole.
As we move toward more personalized and accessible healthcare solutions, early intervention in prosthetic care stands as a model for how innovative thinking can transform medical challenges into opportunities, build a more inclusive society and restore hope.
Special thanks to the Douglas Bader Foundation who have supported this briefing.
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