COMPARISON OF HEALTHCARE COSTS BETWEEN RECONSTRUCTION PROCEDURE AND DIRECT AMPUTATION OF LOWER EXTREMITIES AMONG PATIENTS WITH DIABETIC NEUROPATHIC ARTHROPATHY
Author(s)
Fan He, PhD1, John M. Zanella, MS2, Bijay Silwal, MS3, Arthur de Gast, MD, PhD4, Stefan Maartense, MD, PhD4, Kelly Goodwin Burri, MS5, David Fitch, PhD2;
1Stryker, Mahwah, NJ, USA, 2Stryker, Memphis, TN, USA, 3Stryker, Prosper, TX, USA, 4Stryker, Amsterdam, Netherlands, 5Stryker, Selzach, Switzerland
1Stryker, Mahwah, NJ, USA, 2Stryker, Memphis, TN, USA, 3Stryker, Prosper, TX, USA, 4Stryker, Amsterdam, Netherlands, 5Stryker, Selzach, Switzerland
OBJECTIVES: Diabetic neuroarthropathy (Charcot) is a progressive, destructive joint condition predominantly in the foot and ankle. Limb reconstruction provides mobility and improved quality of life (QoL), while direct amputation, often a premortal event, may be considered due to presumed cost concerns. This study aimed to compare healthcare costs associated with reconstruction versus direct transmetatarsal or more proximal lower-limb amputation for treating diabetic Charcot.
METHODS: Data from 5293 patients who were surgically treated for diabetic Charcot between July 2016 and March 2021 were extracted from the Premier Healthcare Database, a U.S.-based electronic medical records database. The patients were identified using relevant diagnostic and procedure codes (ICD and CPT). Total healthcare costs of the initial surgical treatment and the 3-year follow-up period were normalized to the 2024 U.S. dollar value and separated into major cost categories. The total and category-specific costs were estimated and compared through analysis of covariance.
RESULTS: The total healthcare costs from the initial treatment to the end of 3-year post-surgery were $39,702 and $34,932 for the reconstruction (n=1437) and amputation group (n=3856), respectively (difference=$4,770, p<0.01). While initial treatment costs were significantly higher for reconstruction procedures (difference = $7,156, p<0.01), the follow-up costs were significantly lower (difference=-$3,970, p<0.01). The higher initial surgical cost was driven by orthopedic and surgical supply costs (p<0.01), but the follow-up costs for emergency room, laboratory, room and board, and physical therapy were all significantly lower (p<0.01) than amputation.
CONCLUSIONS: Healthcare costs associated with reconstruction for treating diabetic Charcot were higher at the initial surgery but lower during the 3-year follow-up. This analysis does not include post-amputation prosthetic costs, which can range from $10,000 to upwards of $100,000. When considering these additional costs, the current analysis suggests reconstruction procedures may be more cost effective than direct amputation while prolonging survival and improving QoL.
METHODS: Data from 5293 patients who were surgically treated for diabetic Charcot between July 2016 and March 2021 were extracted from the Premier Healthcare Database, a U.S.-based electronic medical records database. The patients were identified using relevant diagnostic and procedure codes (ICD and CPT). Total healthcare costs of the initial surgical treatment and the 3-year follow-up period were normalized to the 2024 U.S. dollar value and separated into major cost categories. The total and category-specific costs were estimated and compared through analysis of covariance.
RESULTS: The total healthcare costs from the initial treatment to the end of 3-year post-surgery were $39,702 and $34,932 for the reconstruction (n=1437) and amputation group (n=3856), respectively (difference=$4,770, p<0.01). While initial treatment costs were significantly higher for reconstruction procedures (difference = $7,156, p<0.01), the follow-up costs were significantly lower (difference=-$3,970, p<0.01). The higher initial surgical cost was driven by orthopedic and surgical supply costs (p<0.01), but the follow-up costs for emergency room, laboratory, room and board, and physical therapy were all significantly lower (p<0.01) than amputation.
CONCLUSIONS: Healthcare costs associated with reconstruction for treating diabetic Charcot were higher at the initial surgery but lower during the 3-year follow-up. This analysis does not include post-amputation prosthetic costs, which can range from $10,000 to upwards of $100,000. When considering these additional costs, the current analysis suggests reconstruction procedures may be more cost effective than direct amputation while prolonging survival and improving QoL.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE27
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity), SDC: Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal), STA: Surgery