Burden of Diabetic foot Ulcers for Medicare and Private Insurers

OBJECTIVE Estimate the annual, per-patient incremental burden of diabetic foot ulcers (DFUs).

METHODS DFU patients and non-DFU patients with diabetes (controls) were selected using two de-identified databases: ages 65+ from a 5% random sample of Medicare beneficiaries (Standard Analytical Files, 1/2007-12/2010) and ages 18-64 from a privately-insured population (OptumInsight, 1/2007-9/2011). 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, medical resource utilization) and healthcare costs (2012 USD) 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 healthcare (+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 healthcare 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.

CONCLUSION 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.