Burden of Diabetic foot Ulcers for Medicare and Private Insurers

Burden of Diabetic foot Ulcers for Medicare and Private Insurers:

  1. J. Bradford Rice, PhD*
  2. Urvi Desai, PhD*
  3. Alice Kate G. Cummings, BA*,
  4. Howard G. Birnbaum, PhD*
  5. Michelle Skornicki, MPH and
  6. Nathan B. Parsons, RN, BSN
+Author Affiliations

  1. * Analysis Group, Inc. Boston, MA

  2.  Organogenesis, Inc. Canton, MA
  1. Corresponding author: Brad Rice, E-mail: brice@analysisgroup.com.



    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.

    David G. Armstrong

    Dedicated to amputation prevention, wound healing, diabetic foot, biotechnology and the intersection between medical devices and consumer electronics.

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