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Note: This report is greater than 5 years old. Findings may be used for research purposes but should not be considered current.
This report is from AHRQ's Data Points Publication Series.
Beneficiaries with a diabetic foot ulcer are seen by their outpatient health care provider about 14 times per year and are hospitalized about 1.5 times per year. The cost of care for these beneficiaries is substantial, at about $33,000 for total reimbursement of all Medicare services per year.
Beneficiaries with a lower extremity amputation are seen by their outpatient health care provider about 12 times per year and are hospitalized about 2 times per year. The cost of care for these beneficiaries is substantial, at about $52,000 for total reimbursement of all Medicare services per year.
Diabetes mellitus is a significant illness, both from an individual point of view and a societal perspective. According to the Centers for Disease Control and Prevention in 2007, the number of people in the United States (U.S.) with diabetes mellitus reached 24 million, with another 57 million people estimated to have prediabetes.1 From 1980 to 2008, the number of diabetic Medicare beneficiaries aged 65 or older increased from 2.3 million to 7.4 million. In a population of beneficiaries with at least 12 months of continuous enrollment in Medicare Parts A and B fee-for-service (FFS) in 2008, 8.9 million all-age Medicare beneficiaries had diabetes mellitus, or nearly 28 percent of this cohort. The actual national cost burden of diabetes is thought to exceed $174 billion, including the social cost of intangibles such as pain and suffering, care provided by nonpaid caregivers, medical costs associated with undiagnosed diabetes, and diabetes-attributed costs. On average, medical expenditures are thought to be 2.3 times higher in people with diabetes as compared to those without diabetes. Many of these expenditures are likely related to comorbidities associated with diabetes like diabetic foot ulcer (DFU) and lower extremity amputation (LEA).
Common complications of diabetes are foot ulcer and LEA. These complications can have dramatic effects on the patient's health and general well being and can be expensive to treat. For example, in 2001, diabetes-related foot ulcers and amputations were estimated to cost U.S. health care payers $11 billion. Although much effort has been made to determine cost-effectiveness of the care of diabetic individuals with foot ulceration and those who require LEA, questions remain as to whether interventions such as hyperbaric oxygen therapy, negative pressure wound therapy, and specialized dressing materials are really beneficial. Concern for cost-effectiveness has also spurred interest in trying to better understand the potential benefits, if any, of special-needs programs that may be able to provide quality care in an effective and efficient manner for diabetic patients.
Since treatments are changing rapidly, especially for type 2 diabetes (the most common type of diabetes in the Medicare population), it can be difficult for clinicians to keep track of the most useful therapies. This is related, in part, to the fact that there is relatively little standardized data on the treatment or health outcomes for patients with diabetes mellitus. With this background in mind, the goal of this Data Points brief is to evaluate the utilization and costs of services among Medicare beneficiaries with DFUs and/or LEAs. To that end, we focused our analyses on Medicare beneficiaries with Parts A and B FFS or Parts A, B, and D coverage, as defined in the subsequent data source section, for the years 2006 through 2008. In previous Data Points briefs, we reported on the prevalence of diabetes, DFU, and LEA and the incidence of DFU and LEA, among the population of Medicare beneficiaries with Parts A and B FFS coverage.