title: Impact of diabetes on costs before and after major lower extremity amputations in Germany.
abstract: OBJECTIVE
  To compare direct medical costs 1 year before up to 3 years after first major lower extremity amputation (LEA) between patients with and without diabetes.
  
  
  METHODS
  We used health insurance claims data and included patients with a first major LEA between 2005 and 2009. Costs for hospitalization, rehabilitation, outpatient care, outpatient drug prescriptions, non-physician services, durable medical equipment and long-term care were assessed. We estimated cost ratios (CR) for diabetes status using generalized linear models adjusted for age, sex, amputation level, care dependency as well as observation time and mortality within the corresponding period and costs before LEA.
  
  
  RESULTS
  We included 444 patients with first major LEA (58.3% had diabetes), 71.8% were male and the average age was 69.1 years. Total mean costs for 1 year before LEA were higher in patients with diabetes (24,504 vs. 18,961 Euros), which was also confirmed by the multivariate analysis (CR: 1.27; 95% CI: 1.06-1.52). Costs up to 24 weeks after LEA were virtually the same in both groups (36,686 vs. 35,858 Euros), but thereafter differences increase again with higher costs for diabetics. Costs for 3 years after LEA were 115,676 vs. 92,862 Euros, respectively (CR: 1.26; 95% CI: 1.12-1.42). Hospitalizations accounted for more than 50% of total costs irrespective of diabetes status and period.
  
  
  CONCLUSIONS
  Costs up to 24 weeks after first major LEA are mainly driven by the amputation itself irrespective of diabetes. Thereafter, costs for diabetic patients were higher again, which underlines the importance of studying long-term costs.
authors.affiliation: University of Bremen, Centre for Social Policy Research, Division Health Economics, Health Policy and Outcomes Research, Postfach 33 04 40, D-28334, Bremen, Germany. Electronic address: hoffmann@zes.uni-bremen.de.
authors.forename: Falk
authors.initials: F
authors.lastname: Hoffmann
authors.forename: Heiner
authors.initials: H
authors.lastname: Claessen
authors.forename: Stephan
authors.initials: S
authors.lastname: Morbach
authors.forename: Regina
authors.initials: R
authors.lastname: Waldeyer
authors.forename: Gerd
authors.initials: G
authors.lastname: Glaeske
authors.forename: Andrea
authors.initials: A
authors.lastname: Icks
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000191:economics* / Q000706:statistics & numerical data; D000818:Animals; D017281:Cost of Illness; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000191:economics* / Q000453:epidemiology; D017719:Diabetic Foot / Q000191:economics* / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D035002:Lower Extremity / Q000601:surgery; D008297:Male; D008875:Middle Aged
keywords: Amputation; Cost-of-illness study; Diabetes mellitus; Health services research