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Abstract
Medical and pharmaceutical insurance claims associated with lower extremity diabetic
ulcers were examined retrospectively to better understand the costs and duration of
treatment in clinical practice. The study population consisted of working-age individuals
(18 to 64 years old) with health care benefits provided through private employer-sponsored
insurance plans. Diagnostic information contained in the claims database was used
to identify the severity of the ulcers, and the charges associated with treatment
were based on claims data. Claims for lower extremity ulcers were found in 5.1% of
individuals with diabetes. Although many lower extremity ulcers heal with standard
treatment, some are more resistant to treatment and require costly ongoing medical
care. Almost half of these cases were associated with deep infection, osteomyelitis,
or amputation. Total payments for treatment of lower extremity ulcers in this population
averaged $2687 per patient per year, or $4595 per ulcer episode, with inpatient expenditures
accounting for more than 80% of these costs. Costs were significantly higher for patients
with more severe ulcers or with inadequate vascular status in the affected limb. We
concluded that lower extremity ulcers occur in a large number of working-age people
with diabetes and contribute significantly to the morbidity associated with this disease.
The high cost of treating diabetic foot ulcers suggested by this analysis argues for
the development of better treatment strategies and outcomes assessments for these
patients.
Keywords
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References
- Summary.(In: National Diabetes Data Group)in: Diabetes in America. National Institutes of Health, Bethesda, Md1995: 1-14
- Peripheral vascular disease and diabetes.in: Harris MI Hamman RF Diabetes in America. US Government Printing Office, Washington, DC1985: 1-21
- The epidemiology of diabetic foot problems.Diabetic Med. 1996; 13 (Suppl 1): S6-S11
- The distribution and severity of diabetic foot disease: A community study with comparison to a non-diabetic group.Diabetic Med. 1992; 9: 354-358
- The epidemiology of foot lesions in diabetic patients aged 15–50 years.Diabetic Med. 1990; 7: 438-444
- The prevalence and incidence of lower extremity amputation in a diabetic population.Arch Intern Med. 1992; 152: 610-616
- Lower extremity foot ulcers and amputation in diabetes.(In: National Diabetes Data Group)in: Diabetes in America. National Institutes of Health, Bethesda, Md1995: 409-428
- Diabetic foot ulcers: Etiology, treatment, and prevention.Adv Intern Med. 1991; 37: 103-132
- A 4-year outcome-based retrospective study of wound healing and limb salvage in patients with chronic wounds.Adv Wound Care. 1997; 1: 33-38
- Cost-effective management of diabetic foot ulcers.PharmacoEconomics. 1997; 12: 42-53
- Diabetic foot ulcers in a multidisciplinary setting: An economic analysis of primary healing and healing with amputation.J Intern Med (GBR). 1994; 235: 463-471
- The course of severe foot infection in patients with diabetes.Surg Gynecol Obstet. 1992; 175: 135-140
- The association between clinical risk factors and outcome of diabetic foot ulcers.Diabetes Res Clin Pract. 1992; 18: 43-53
- Trends in the care of the diabetic foot. Expanded role of arterial reconstruction.Arch Surg. 1992; 127: 617-621
- Improved quality of diabetic foot care, 1984 vs 1990. Reduced length of stay and costs, insufficient reimbursement.Arch Surg. 1993; 128: 576-581
- Cost of treating advanced leg ischemia. Bypass graft vs primary amputation.Arch Surg. 1988; 123: 495-496
- Use of subsequent anticoagulants to increase the predictive value of Medicaid deep venous thromboembolism diagnoses.Epidemiology. 1990; 1: 122-127
- Using administrative data to describe casemix: A comparison with the medical record.J Clin Epidemiol. 1994; 47: 1027-1032
- Using claims data for epidemiologic research.Med Care. 1993; 41: 498-507
- Accuracy of coding in Medicare part B claims.Arch Ophthalmol. 1993; 111: 605-607
- The ischemic heart disease patient outcomes research team. A comparison of administrative versus clinical data: Coronary artery bypass surgery as an example.J Clin Epidemiol. 1994; 47: 249-260
- Comparing clinical information with claims data: Some similarities and differences.J Clin Epidemiol. 1991; 44: 881-888
- Estimating the burden of disease: Comparing administrative data and self-reports.Med Care. 1997; 35: 932-947
- Discordance of databases designed for claims payment versus clinical information systems.Ann Intern Med. 1993; 119: 844-850
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© 1998 Published by Elsevier Inc.
