Economic value of 3D-printed prostheses: Policy implications from a choice experiment in South Korea

초록

Background: Upper-limb amputation has a significant impact on physical function and productivity. Despite the potential benefits, many amputees abandon prostheses due to limited functionality-affordability options, and insurance systems leave coverage gaps between low-cost cosmetic and expensive myoelectric devices. Objective: This study examines heterogeneous consumer preferences for forearm prostheses across sociodemographic groups and assesses the economic viability of extending insurance coverage to intermediate-functionality devices enabled by 3D-printing technology in the Korean healthcare system. Methods: A discrete choice experiment with 701 Korean adults examined preferences for prosthetic attributes under hypothetical amputation scenarios. Hierarchical Bayesian mixed logit modeling analyzed preference heterogeneity by age and occupation. Market simulations predicted adoption of intermediate devices, and a 20-year cost-benefit analysis considered return-to-work benefits and consumer surplus. Results: Willingness-to-pay for advanced dexterity has a significant weight in device choice, with clear differences between groups. Market share simulations suggest 3D-printed mid-functional prostheses would capture 27.4-31.0% of the market, primarily substituting the market for extremely expensive high-end prostheses. While productivity gains alone were insufficient to justify coverage (BCR 0.31), the inclusion of consumer surplus led to a societal benefit-cost ratio of 3.24. Conclusions: Forearm prostheses with intermediate functionality could fill the unmet demand between basic and premium products. Expanding public insurance coverage to these intermediate options generates positive economic returns by restoring labor productivity in younger amputees and enhancing quality of life for older users. The results suggest that differentiated reimbursement strategies tailored to age and occupation could optimize resource allocation and improve equity within public healthcare systems.

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