title: Cost of lower-limb amputation in U.S. veterans with diabetes using health services data in fiscal years 2004 and 2010.
abstract: The purpose of this study was to estimate healthcare costs associated with diabetes-related lower-limb amputations (LLAs) within the Veterans Health Administration (VHA). We performed a cross-sectional comparative analysis of 3,381 VHA clinic users in fiscal year (FY) 2004 and 3,403 clinic users in FY2010 identified as having type 2 diabetes mellitus and nontraumatic LLA. LLA expenditures related to inpatient medical, inpatient surgical, and outpatient care were estimated using VHA Health Economics Resource Center average cost files. LLA-related pharmaceutical costs were obtained from VHA Decision Support System national extract files. From the Department of Veterans Affairs (VA) perspective, the mean cost associated with care for diabetes-related LLA per patient in the VA healthcare system in FY2004 was $50,351 (95% confidence interval [CI] = 48,939-51,803) in U.S. dollars; the total cost for all 3,381 patients was $170,236,037. In FY2010, cost per patient rose to $60,647 (95% CI = 59,143-62,188), with a total cost of $206,380,331 for 3,403 patients. In the VHA healthcare system, the economic burden associated with LLAs in patients with diabetes exceeded $200,000,000 in FY2010. This suggests that further improvements in care of patients with diabetes could be associated with significant cost savings.
authors.affiliation: Department of Veterans Affairs New Jersey Health Care System, East Orange Campus, East Orange, NJ;
authors.forename: Heather
authors.initials: H
authors.lastname: Franklin
authors.forename: Mangala
authors.initials: M
authors.lastname: Rajan
authors.forename: Chin-Lin
authors.initials: CL
authors.lastname: Tseng
authors.forename: Len
authors.initials: L
authors.lastname: Pogach
authors.forename: Anushua
authors.initials: A
authors.lastname: Sinha
authors.forename: Md
authors.initials: M
authors.lastname: Mph
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000191:economics*; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000191:economics* / Q000601:surgery*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014481:United States; D058014:Veterans Health / Q000191:economics*
keywords: LLA expenditures; VA; VHA; Veterans Health Administration; amputations; cost; diabetes; health services; lower-limb amputations; veteran