Economic Impact of Diabetes-Related Foot Amputations in Germany From the Payer's Perspective: An Extrapolation of German SHI Data

OBJECTIVES: Diabetes mellitus (DM) is one of the most common diseases in Germany, associated with up to 75% of all lower limb amputations in Germany and lead to high medical costs. The aim of this analysis was to calculate the incidence of foot amputations from German real-world data, extrapolate it to the statutory health insurance (SHI) population and calculate the resulting costs.

METHODS: Data basis was an anonymized, age- and gender-adjusted German claims data analysis from 2014-2019 with approx. 4.9 million SHI enrollees. OPS codes for “minor foot amputation” (5-865.0 - 5-865.9) were used to identify patients with amputations. The calculated prevalence of DM, the incidence of minor foot amputations per 1,000 DM-patients, and the ratio of minor to major amputations from comparable real-world data were used to calculate the annual number of diabetes-related amputations in the SHI population. These were multiplied by the average annual cost in the year of amputation and in the follow-up year.

RESULTS: In the ~4.9 million claims analyzed, 434,615 enrollees had DM, a prevalence of 8.9%. Of these, 1,674 minor amputations were reported within 12 months which corresponds to an incidence of 3.85 per 1,000 DM patients. Extrapolated to the SHI population, this results in 25,474 annual minor amputations. Using a minor to major amputation ratio of 2.72 to 2.81, this results in 9,065 to 9,365 major amputations and therefore 34,539 to 34,839 diabetes-related amputations per year. Multiplied by the average annual cost of €19,725 in the year of amputation and €12,160 in the follow-up year, the total cost to the SHI system in the first 2 years after amputation is €1,101,276,015-1,110,841,515.

CONCLUSIONS:

Diabetes-related foot amputations represent an economic burden for the German healthcare system. The trend in recent years has been towards more minor and fewer major amputations.