Burden of Diabetic Foot Ulcers for Medicare and Private Insurers

Abstract

OBJECTIVE To estimate the annual, per-patient incremental burden of diabetic foot ulcers (DFUs). RESEARCH DESIGN AND METHODS DFU patients and non-DFU patients with diabetes (controls) were selected using two deidentified databases: ages 65+ years from a 5% random sample of Medicare beneficiaries (Standard Analytical Files, January 2007–December 2010) and ages 18–64 years from a privately insured population (OptumInsight, January 2007–September 2011). Demographics, comorbidities, resource use, and costs from the payer perspective incurred during the 12 months prior to a DFU episode were identified. DFU patients were matched to controls with similar pre-DFU characteristics using a propensity score methodology. Per-patient incremental clinical outcomes (e.g., amputation and medical resource utilization) and health care costs (2012 U.S. dollars) during the 12-month follow-up period were measured among the matched cohorts. RESULTS Data for 27,878 matched pairs of Medicare and 4,536 matched pairs of privately insured patients were analyzed. During the 12-month follow-up period, DFU patients had more days hospitalized (+138.2% Medicare, +173.5% private), days requiring home health care (+85.4% Medicare, +230.0% private), emergency department visits (+40.6% Medicare, +109.0% private), and outpatient/physician office visits (+35.1% Medicare, +42.5% private) than matched controls. Among matched patients, 3.8% of Medicare and 5.0% of privately insured DFU patients received lower limb amputations. Increased utilization resulted in DFU patients having $11,710 in incremental annual health care costs for Medicare, and $16,883 for private insurance, compared with matched controls. Privately insured matched DFU patients incurred excess work-loss costs of $3,259. CONCLUSIONS These findings document that DFU imposes substantial burden on public and private payers, ranging from $9–13 billion in addition to the costs associated with diabetes itself.

Cost of Illness of Diabetic Foot Ulcer in a Resource Limited Setting: A Study from Northwestern Nigeria

“…Medication on the other hand only represented 10% of the total costs. Also in a Medicare analysis done in the United States between 2007 and 2010, hospitalization was found to contribute 62.5% of the total costs of illness while prescription drug contributed only 5.9% [30]. Patients in our study tend to rely on traditional medication and orthodox drugs,for treatment rather than surgical care because of lack of affordability of surgical management.…”

Social deprivation modifies the association between incident foot ulceration and mortality in type 1 and type 2 diabetes: a longitudinal study of a primary-care cohort

“…The incidence in Europe is around 2% per year [8]. Costs of care are double those seen in individuals without ulceration [9], with the total cost associated with treatment being as high as €10 billion per year in Europe [8]. The incidence of foot ulcers is 2.2% per annum in the UK, and an average of 6000 people with diabetes each year undergo amputation [10,11].…”

Economic outcomes among Medicare patients receiving bioengineered cellular technologies for treatment of diabetic foot ulcers

“…For example, prior studies have identified DFU duration as an independent risk factor for the development of a foot infection, and that, the risk of hospitalization was 55.7-times greater and the risk of amputation was 154.5-times greater than those who did not develop foot infections 6 . Approximately 5% of diabetes patients with foot ulceration require a lower-limb amputation within the year following a DFU diagnosis compared to almost no amputations among those without DFUs 7 . Further, foot ulceration is one of the major sources of hospitalizations among patients with diabetes and has been estimated to precede more than four out of every five lower-limb amputations in these patients 4,8 .…”