Burden of Diabetic foot Ulcers for Medicare and Private Insurers

NewsBot · Nov 5, 2013

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Burden of Diabetic foot Ulcers for Medicare and Private Insurers
J. Bradford Rice, Urvi Desai, Alice Kate G. Cummings, Howard G. Birnbaum, Michelle Skornicki, Nathan B. Parsons
Diabetes Care November 1, 2013

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.
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Admin2 · Nov 5, 2013

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NewsBot · Jan 29, 2014

Burden of diabetic foot disorders, guidelines for management, and disparities in implementation in Europe: a systematic literature review.
van Acker K, Léger P, Hartemann A, Chawla A, Siddiqui MK.
Diabetes Metab Res Rev. 2014 Jan 27.

OBJECTIVE:
The study aimed to assess the economic and quality of life (QoL) burden of diabetic foot (DF) disorders and to identify disparities in the recommendations from guidelines and the current clinical practice across the EU5 (Spain, Italy, France, UK, and Germany) countries.
METHODS:
Literature search of electronic databases (MEDLINE®, Embase®, and Cochrane Database of Systematic Reviews) was undertaken. English language studies investigating economic and resource burden, QoL, and management of DF disease in the EU5 countries were included. Additionally, websites were screened for guidelines and current management practices in DF complication in EU5.
RESULTS:
DF complications accounted for a total annual cost of €509 million in the UK and €430 per diabetic patient in Germany, during 2001. The cost of DF complications increased with disease severity, with hospitalisations (41%) and amputation (9%) incurring 50% of the cost. Medical devices (orthopaedic shoes, shoe lifts, and walking aids) were the most frequently utilised resources. Patients with DF complications experienced worsened QoL, especially in those undergoing amputations and with non-healed ulcers or recurrent ulcers. Although guidelines advocate the use of multidisciplinary foot care team (MFC), the utilisation of MFC was suboptimal.
CONCLUSIONS:
DF disorders demonstrated substantial economic burden and have detrimental effect on QoL, with more impairment in physical domain. Implementation of the guidelines and set-up of multidisciplinary clinics for holistic management of the DFD varies across Europe and remains suboptimal. Hence, guidelines need to be reinforced to prevent DF complications and to achieve limb salvage if complications are unpreventable
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NewsBot · Jan 31, 2014

The costs of treating long-term diabetic complications in a developing country: a study from India.
Kumpatla S, Kothandan H, Tharkar S, Viswanathan V.
J Assoc Physicians India. 2013 Feb;61(2):102-9.

OBJECTIVE:
Diabetes is a major public health problem associated with huge economic burden in developing countries. The aim was to assess the direct costs of treating long-term diabetic complications among hospitalized subjects with type 2 diabetes.
METHODS:
A total of 368 (M: F, 254:114) hospitalized patients were divided into groups based on the presence of complications and were compared with a group without any complications (Group 1; n = 86), Group 2; n = 67 with chronic kidney disease, Group 3; n = 53 with cardiovascular complications, Group 4; n = 58 who underwent foot amputation, Group 5; n = 66 with retinal complications and Group 6; n = 38 with presence of two complications. Details on socio-demography, hospitalization, direct costs of all inpatient care were recorded. The data on expenditure was obtained from hospital bills.
RESULTS:
The patients with foot complications or with presence of two diabetic complications tend to stay long for every inpatient admission. On an average, patients with foot complications (19020 INR) and those who had two complications (17633 INR) spent four times more and patients with renal disease (12690 INR), cardiovascular (13135 INR) and retinal complications (13922 INR) spent three times more than patients without any complications (4493 INR). The median expenditure for hospital admissions for the previous two years was higher for patients with foot and cardiovascular complications and it was highest if they had presence of two complications.
CONCLUSIONS:
The present study highlights the direct cost estimates and economic burden of treating severe long-term diabetic complications. It is therefore important that emphasize should be placed on primary and secondary preventive measures of diabetes.
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NewsBot · May 13, 2017

Health Care Service and Outcomes Among an Estimated 6.7 Million Ambulatory Care Diabetic Foot Cases in the U.S.
Skrepnek GH et al
Diabetes Care. 2017 May 11.pii: dc162189. doi: 10.2337/dc16-2189.

OBJECTIVE:
To evaluate ambulatory clinical cases of diabetic foot ulcers (DFUs) and diabetic foot infections (DFIs) in the U.S. from 2007 to 2013 and to assess outcomes of emergency department or inpatient (ED/IP) admission, number of clinic visits per year, and physician time spent per visit.
RESEARCH DESIGN AND METHODS:
A cross-sectional historical cohort analysis was conducted by using the nationally representative Centers for Disease Control and Prevention National Ambulatory Medical Care Survey data from 2007 to 2013, including patients age ≥18 years with diabetes and either DFIs or DFUs. Study outcomes were analyzed by using generalized linear models controlling for key demographics and chronic conditions.
RESULTS:
Across the estimated 5.6 billion ambulatory care visits between 2007 and 2013, 784.8 million involved diabetes and ∼6.7 million (0.8%) were for DFUs (0.3%) or DFIs (0.5%). Relative to other ambulatory clinical cases, multivariable analyses indicated that DFUs were associated with a 3.4 times higher odds of direct ED/IP admission (CI 1.01-11.28; P = 0.049), 2.1 times higher odds of referral to another physician (CI 1.14-3.71; P = 0.017), 1.9 times more visits in the past 12 months (CI 1.41-2.42; P < 0.001), and 1.4 times longer time spent per visit with the physician (CI 1.03-1.87; P = 0.033). DFIs were independently associated with a 6.7 times higher odds of direct ED referral or IP admission (CI 2.25-19.51; P < 0.001) and 1.5 times more visits in the past 12 months (CI 1.14-1.90; P = 0.003).
CONCLUSIONS:
This investigation of an estimated 6.7 million diabetic foot cases indicates markedly greater risks for both ED/IP admissions and number of outpatient visits, with DFUs also associated with a higher odds of referrals to other physicians and longer physician visit times.
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NewsBot · Jul 6, 2023

Study to Evaluate the Pharmacoeconomics in Diabetic Foot Ulcer Management
Robin George Eluru Niranjani Mandla Rekha Golla Sai Teja Sarangan Nithya Lakshmi Ellampati Sunil Kumar
Source

Background: Diabetic foot ulceration (DFU) is one of the macrovascular complications of diabetes, its prevalence was estimated to be about 8-11% of individuals with uncontrolled diabetes experience for long time. The pathogenic cascade of DFU is a combination of vascular complications of peripheral arteries, Peripheral neuropathy and the raised blood glucose makes it as a non-healing ulcer followed by secondary infection which will progress to end with leg Amputation. The recurrent nature of Diabetic foot ulcer can impact on the health status as well as the economical stability of the affected patients and are associated with the major health care consumption with high cost.

Methodology: It was a Mono centered prospective observational comparative study conducted in the department of general surgery for 6 months duration.

Results: Total samples of 100 diabetic foot ulcer patients were enrolled into the study, 74 (74%) were males and 26 (26%) were females. The age group between51-60 and 61-70 years was observed as the highest percentage 27% (27). Highest percentage 42% (42) of patients were none (without any comorbidities) followed by 32(32%) patients are with combined (more than one comorbidity like HTN, CKD, CAD…etc.) with utmost percentage of 43% was peripheral neuropathy. 23 patients were diagnosed with gangrene and23 patients underwent major amputation, The economic burden of diabetic foot ulcer for conservative treatment was slightly more when compared to amputated patients.

Conclusion: Study concludes that, economic burden on diabetic foot ulcer in conservative patients was slightly more while compared to amputated patients by descriptive statistics even the statistical analysis shown less significant difference. Because the necessity rate for extra hospitalization and medical services was more for conservative treatment (Debridement, Fasciotomy, Incision and Drainage) when compared to amputation patients with diabetic foot ulcer. whereas in the pharmaco-economics there was not much significant difference among both amputated and conservative patients.
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