Potential economic benefits of lower-extremity amputation prevention strategies in diabetes.
OBJECTIVE
To estimate the potential economic benefits of selected strategies from published literature--educational interventions, multidisciplinary clinics, and insurance coverage for therapeutic shoes--to reduce the incidence of lower-extremity amputation among individuals with diabetes.


METHODS
We developed a model to estimate the expected incidence and associated costs of lower-extremity amputation in a hypothetical cohort of 10,000 people with diabetes. Prevention strategies were assumed to be targeted at individuals with a history of foot ulcer, and benefits were estimated over a period of 3 years.


RESULTS
The total potential economic benefits (discounted at 5%) of strategies to reduce amputation risk ranged from $2.0 to $3.0 million ($2,900 to $4,442 per person with a history of foot ulcer) over 3 years. Benefits were highest for educational interventions. Most benefits were found to accrue among individuals aged > or = 70 years.


CONCLUSIONS
Strategies to reduce the risk of lower-extremity amputation may generate substantial economic benefits and should be a standard component of routine diabetes care. Benefits may best be achieved through a partnership of government, private payers, health care service providers and producers, and individuals with diabetes.
Policy Analysis Incorporated, Brookline, Massachusetts, USA.
D A
DA
Ollendorf
J G
JG
Kotsanos
W J
WJ
Wishner
M
M
Friedman
T
T
Cooper
M
M
Bittoni
G
G
Oster
D000367:Age Factors; D000671:Amputation, Surgical / Q000191:economics* / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003920:Diabetes Mellitus / Q000191:economics / Q000628:therapy*; D017719:Diabetic Foot / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D004496:Education, Continuing; D016523:Foot Ulcer / Q000191:economics / Q000517:prevention & control; D006282:Health Personnel / Q000193:education; D006801:Humans; D015994:Incidence; D007866:Leg; D015233:Models, Statistical; D010353:Patient Education as Topic; D015203:Reproducibility of Results; D012775:Shoes / Q000191:economics; D014481:United States / Q000453:epidemiology