A cost analysis of diabetic lower-extremity ulcers.
OBJECTIVE
Our objectives were to 1) estimate the prevalence of diabetes and diabetic lower-extremity ulcers in the Medicare population, 2) characterize Medicare population-specific costs for lower-extremity ulcer episodes, and 3) evaluate potential cost savings associated with better healing of lower-extremity ulcers.


METHODS
Prevalence and costs of diabetic lower-extremity ulcers were obtained by an analysis of Medicare claims data from 1995 and 1996 Standard Analytic Files (5% sample).


RESULTS
Medicare expenditures for lower-extremity ulcer patients were on average 3 times higher than those for Medicare patients in general ($15,309 vs. $5,226). Lower-extremity ulcer-related spending accounted for 24% of total spending for lower-extremity ulcer patients. Most of the ulcer-related costs accrued on the inpatient side (73.7%); proportionately smaller amounts went to physicians and nursing home facilities. To determine the potential effect of better diabetic ulcer management, a model was created that estimated the impact on costs with improved healing rates. Improving the 20-week healing rate from 31 to 40% would save Medicare $189 per episode.


CONCLUSIONS
Lower-extremity ulcers cost the Medicare system $1.5 billion in 1995. Any wound care intervention that could prevent even a small percentage of wounds from progressing to the stage at which inpatient care is required may have a favorable cost effect on the Medicare system.
Harrington
C
C
Lewin Group, Falls Church, Virginia 22042, USA. catherine.harrington@lewin.com
Zagari
M J
MJ
Corea
J
J
Klitenic
J
J
D000368:Aged; D000465:Algorithms; D000671:Amputation, Surgical / Q000191:economics / Q000706:statistics & numerical data; D003365:Costs and Cost Analysis; D003920:Diabetes Mellitus / Q000191:economics* / Q000453:epidemiology*; D017719:Diabetic Foot / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy; D016523:Foot Ulcer / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D006278:Medicare; D015995:Prevalence; D014481:United States / Q000453:epidemiology