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Diabetic Foot Ulcers and the Economic Burden on Insurers

Patients with diabetic foot ulcers have an annual burden on yearly Medicare of $11,710…. 

Diabetic foot ulcers are a common complication among diabetic patients. Since many diabetics have comorbid neuropathy, they may have a foot ulcer and not immediately know it. Diabetic patients also commonly have vasculature damage due to their elevated glucose, impeding the ability of the immune system to reach the site of infection. Patients with diabetes are at an increased risk of foot ulcers and often limb-threatening infections. With the baby-boomer generation retiring, the incidence of diabetic foot infections will most likely increase since the majority of type 2 diabetic patients are found in the older patient population and this population is growing.

The objective of this study was to estimate the annual, per-patient incremental burden of diabetic foot ulcers. Patients with diabetic foot ulcers were randomly selected from a Medicare beneficiary database and compared with non-diabetic foot ulcer patients, serving as controls. Patients were matched based upon similar characteristics to help limit confounding variables.

The researchers identified patient demographics, comorbidities, resource use and costs (payer perspective) within 12 months prior to the diagnosis of a diabetic foot ulcer. Among the matched cohorts, health care costs (in 2012 US dollars) and per-patient incremental clinical outcomes were measured.

For Medicare patients, there were 27,878 pairs of patients matched to controls and for privately insured patients, there were a total of 4,536 matched.

After matching patients to non-diabetic controls, data was analyzed over a 12 month follow-up period. Compared to matched controls, patients with diabetic foot ulcers had:

  • more days hospitalized (Medicare +138.2%, Private +173.5%)
  • more days requiring home health care (Medicare +85.4%, Private +230.0%),
  • more emergency department visits (Medicare +40.6%, Private +109.0%)
  • more and outpatient/physician office visits (Medicare +35.1%, Private +42.5%)

Further, diabetic foot ulcer patients showed an increased utilization of health care, having $11,710 in incremental annual health care costs for Medicare, and $16,883 for private insurance.

The authors concluded that diabetic foot ulcers result in a substantial burden on both private and public payers, ranging from $9 to 13 billion – not including the costs associated with diabetes itself.

Practice Pearls:
  • Diabetic foot ulcers are a major cause of hospitalization among diabetics.
  • Diabetic foot ulcers impose substantial costs for both Medicare and private payers.
  • Maintaining control over blood glucose levels can prevent diabetic foot ulcers and not only increase quality of life but also save substantially in heath care costs.

Rice JB, Desai U, Cummings AK, Birnbaum HG, Skornicki M, Parsons NB. Burden of diabetic foot ulcers for medicare and private insurers. Diabetes Care. 2014;37(3):651-8.