Substantial Costs for Diabetes Are Consumed by the Diabetic Foot and Arthritis

August 2013, Vol 6 ADA 2013 Highlights
Mary Mosley

Chicago, IL—Diabetes foot infection comprised 2.5 million (3.8%) of the 66.1 million diabetes-related inpatient visits that occurred between 2001 and 2010 in the United States, according to data presented at the 2013 American Diabetes Association annual meeting.

The Economic Burden of the Diabetic Foot
The cost associated with the diabetic foot was $113 billion (2012 US dollars; mean, $11.3 billion annually). The data were compiled from discharge records from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project, and were presented by Grant H. Skrepnek, PhD, RPh, Assistant Professor, University of Arizona College of Pharmacy, Tucson, AZ.

Of the 66.1 million diabetes-related inpatient visits between 2001 and 2010, 2.5 million involved patients with diabetic foot infections. The average cost for a patient with a diabetic foot was $46,107 per case. The primary payers included Medicare, for 63% of the patients; Medicaid, for 11% of the patients; and private insurance for 19%. Inpatient mortality occurred in 2.3% of the patients, sepsis in 8%, and surgical complications in 11%.

Of note, from 2006 to 2010, diabetic foot was the cause of 1 million cases presenting to the emergency department in the United States, approximately 1.9% of the total diabetes cases, at a cost of $1.2 billion. When the cost of inpatient charges was included for the 81.2% of emergency department visits for patients who were subsequently admitted, the costs increased by $41.5 billion.

Loss of Preventive Services for Diabetic Foot Costs Money
Inpatient medical costs for the care of the diabetic foot were increased by $44 for every $1 that was not spent on preventive services, according to this retrospective analysis by Dr Skrepnek and colleagues, who investigated the impact of the cancellation of reimbursement coverage for podiatric physicians for Medicaid beneficiaries, as part of healthcare cost-containment legislation that took effect in 2010 in Arizona.

During the index period from 2006 to 2010, the total cost for the 4663 inpatient cases of diabetic foot was $234 million (2010 US dollars). The mean length of stay was 7.1 days, and the mean charges were $50,096 ± $56,888.

The increased inpatient medical costs after 2010 resulted from a 37.5% increase in diabetic foot admissions, with a 45% increased cost in medical charges. The length of stay was increased by 29%, and the severe aggregated outcomes (ie, mortality, amputation, sepsis, surgical complications) increased from 30% before the 2010 change in reimbursement to 50% after.

“The inpatient burden of diabetic foot disease is substantial in terms of morbidity, mortality, and costs. Increased outpatient prevention and management may ultimately lessen the clinical and economic impact of this condition,” the investigators concluded.

Arthritis Adds Significant Economic Toll to Diabetes Care
A second analysis of the economic burden of arthritis in patients with diabetes was presented at the meeting by Rui Li, PhD, of the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA. Approximately 50% of adults with diabetes have arthritis, but the associated costs have not been well studied before.

Using data from the 2009 and 2010 Medical Expenditure Panel Survey, Dr Li and his team found that the treatment of arthritis accounted for 16% of the total medical costs in patients with diabetes. The mean costs were greater for patients who had diabetes and arthritis than for patients who “only” had diabetes and no arthritis.

The following costs reflected the annual increase in costs per patient with diabetes who also had arthritis compared with a patient with diabetes alone:

  • The total medical costs were $2897 higher (ie, 23% more)
  • Inpatient care was $620 higher (17% more)
  • Outpatient care was $1025 higher (43% more)
  • Prescription drug costs were $849 higher (32% more).

The investigators recommended that diabetes control programs include components to address arthritis, including physical activity and chronic disease self-management edu­cation courses, which are evidence-based strategies to improve arthritis and diabetes.

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