title: Burden of diabetic foot ulcers for medicare and private insurers.
abstract: OBJECTIVE
  To estimate the annual, per-patient incremental burden of diabetic foot ulcers (DFUs).
  
  
  METHODS
  DFU patients and non-DFU patients with diabetes (controls) were selected using two de-identified databases: ages 65+ years from a 5% random sample of Medicare beneficiaries (Standard Analytical Files, January 2007-December 2010) and ages 18-64 years from a privately insured population (OptumInsight, January 2007-September 2011). Demographics, comorbidities, resource use, and costs from the payer perspective incurred during the 12 months prior to a DFU episode were identified. DFU patients were matched to controls with similar pre-DFU characteristics using a propensity score methodology. Per-patient incremental clinical outcomes (e.g., amputation and medical resource utilization) and health care costs (2012 U.S. dollars) during the 12-month follow-up period were measured among the matched cohorts.
  
  
  RESULTS
  Data for 27,878 matched pairs of Medicare and 4,536 matched pairs of privately insured patients were analyzed. During the 12-month follow-up period, DFU patients had more days hospitalized (+138.2% Medicare, +173.5% private), days requiring home health care (+85.4% Medicare, +230.0% private), emergency department visits (+40.6% Medicare, +109.0% private), and outpatient/physician office visits (+35.1% Medicare, +42.5% private) than matched controls. Among matched patients, 3.8% of Medicare and 5.0% of privately insured DFU patients received lower limb amputations. Increased utilization resulted in DFU patients having $11,710 in incremental annual health care costs for Medicare, and $16,883 for private insurance, compared with matched controls. Privately insured matched DFU patients incurred excess work-loss costs of $3,259.
  
  
  CONCLUSIONS
  These findings document that DFU imposes substantial burden on public and private payers, ranging from $9-13 billion in addition to the costs associated with diabetes itself.
authors.affiliation: Corresponding author: J. Bradford Rice, brice@analysisgroup.com.
authors.forename: J Bradford
authors.initials: JB
authors.lastname: Rice
authors.forename: Urvi
authors.initials: U
authors.lastname: Desai
authors.forename: Alice Kate G
authors.initials: AK
authors.lastname: Cummings
authors.forename: Howard G
authors.initials: HG
authors.lastname: Birnbaum
authors.forename: Michelle
authors.initials: M
authors.lastname: Skornicki
authors.forename: Nathan B
authors.initials: NB
authors.lastname: Parsons
mesh_terms: D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical / Q000191:economics; D015897:Comorbidity; D017281:Cost of Illness; D017719:Diabetic Foot / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007343:Insurance Carriers / Q000191:economics; D008297:Male; D006278:Medicare / Q000191:economics*; D008875:Middle Aged; D017149:Private Sector / Q000191:economics*; D057216:Propensity Score; D014481:United States; D055815:Young Adult