title: Cost comparison: limb salvage versus amputation in diabetic patients with charcot foot.
abstract: BACKGROUND
  The negative impact on health-related quality of life in patients with Charcot foot has prompted operative correction of the acquired deformity. Comparative effectiveness financial models are being introduced to provide valuable information to assist clinical decision making.
  
  
  METHODS
  Seventy-six patients with Charcot foot underwent operative correction with the use of circular external fixation. Thirty-eight (50%) had osteomyelitis. A control group was created from 17 diabetic patients who successfully underwent transtibial amputation and prosthetic fitting during the same period. Cost of care during the 12 months following surgery was derived from inpatient hospitalization, placement in a rehabilitation unit or skilled nursing facility, home health care including parenteral antibiotic therapy, physical therapy, and purchase of prosthetic devices or footwear.
  
  
  RESULTS
  Fifty-three of the patients with limb salvage (69.7%) did not require inpatient rehabilitation. Their average cost of care was $56,712. Fourteen of the patients with amputation (82.4%) required inpatient rehabilitation, with an average cost of $49,251.
  
  
  CONCLUSIONS
  Many surgeons now favor operative correction of Charcot foot deformity. This investigation provides preliminary data on the relative cost of transtibial amputation and prosthetic limb fitting compared with limb salvage. The use of comparative effectiveness models such as this simple attempt may provide valuable information in planning resource allocation for similar complex groups of patients.
  
  
  METHODS
  Level III, economic and decision analysis.
authors.affiliation: Department of Orthopaedic Surgery, Brown University, Providence, RI, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Gil
authors.forename: Adam P
authors.initials: AP
authors.lastname: Schiff
authors.forename: Michael S
authors.initials: MS
authors.lastname: Pinzur
mesh_terms: D000671:Amputation, Surgical / Q000191:economics*; D001177:Arthropathy, Neurogenic / Q000150:complications / Q000191:economics / Q000601:surgery*; D001186:Artificial Limbs / Q000191:economics; D017281:Cost of Illness; D017719:Diabetic Foot / Q000150:complications / Q000191:economics / Q000601:surgery*; D017721:Hospital Costs; D006801:Humans; D023821:Limb Salvage / Q000191:economics*; D014481:United States
keywords: arthritis; diabetes; neuromuscular disorders; outcome studies; statistical analysis