This from our team USC and colleagues Paul Saatsoglou and Susan Pitman-Lowenthal.
Bottom line: This study analyzed the cost of treating neuroischemic ulcers (a type of wound) on the lower extremities in patients with peripheral artery disease using medical and hospital claims records submitted for reimbursement to private insurance, Medicare, and Medicaid. The study population consisted of 42,837 anonymized patients and the analysis used the metric of “submitted charges” to account for differences in reimbursement across insurance payers. The average treatment cost for all patients with ulcers was $94,100 per patient, with the most expensive subtype being nonpressure ulcers of the heel/midfoot at $121,400 per patient. Patients who also had a surgical procedure had an average cost of $121,000 per patient, with the most expensive surgical codes being complications of vascular prosthetic devices, implants, and grafts at $146,900 per patient. The combination of the most expensive ulcer and the most expensive surgery had an average cost of $177,400 per patient. The study concluded that the burden of managing neuroischemic ulcers in patients with peripheral artery disease is significant and efforts to reduce this burden may help reduce resource utilization.
Paul A Saatsoglou , Susan Pitman Lowenthal , David G Armstrong
Background: We evaluated the cost of treating neuroischemic ulcers of the lower extremity in patients with peripheral artery disease by using medical and hospital claims records submitted for reimbursement to payers (private insurance, Medicare, Medicaid).
Methods: Adjudicated claims and remittance data on claims that include submitted charges, line items paid by insurers directly to providers and patient payments of copays, deductibles and co-insurance were used. Eligible patients from a commercial database containing more than 60% of US patients with health insurance were analyzed. Patient selection, performed using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes, yielded a study population of 42,837 unique anonymized patients.
Results: Using the metric of “submitted charges” to overcome differences in levels of reimbursement across insurance payers and Medicare/Medicaid, we identified 34,348 patients with ulcers with an average treatment cost of $94,100 per patient ($41,800 annualized) The costliest ulcer subtype was nonpressure ulcer of the heel/midfoot among 13,184 patients with $121,400 per patient ($53,900 annualized), 29% higher than across all ulcer types. The subset of 22,281 ulcer patients who also had a surgical procedure incurred costs of $121,000 per patient ($53,800 annualized). The costliest surgical codes were complications of vascular prosthetic devices, implants, grafts among 6444 patients with $146,900 per patient ($65,300 annualized). The combination of most expensive ulcer and most expensive surgery yielded a cohort of 2355 patients with the highest average cost of $177,400 per patient ($78,800 annualized).
Conclusions: The resource burden for management of neuroischemic ulcers of the lower extremity in patients with peripheral artery disease is substantial. Mitigating this burden may help reduce significant resource utilization.
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