COST OF AMPUTATION FOLLOWING LOWER EXTREMITY ENDOVASCULAR REVASCULARIZATION IN PERIPHERAL ARTERY DISEASE
Author(s)
Alysha M. McGovern, MBA, Vasilios Janinis, BS, Nicholas Anderson, MA, MBA, Abimbola O. Williams, MPH, MS, Michael R. Jaff, DO;
Boston Scientific, Marlborough, MA, USA
Boston Scientific, Marlborough, MA, USA
OBJECTIVES: Peripheral artery disease (PAD) has well-recognized clinical consequences, yet hospital costs among patients who progress to amputation after endovascular revascularization procedures are not well-characterized. This study quantified the hospital costs of lower extremity (LE) amputations after endovascular interventions in PAD patients.
METHODS: A retrospective cost analysis was conducted using the Premier PINC AI™ Healthcare Database. Adults aged 18+ with a PAD diagnosis from 01/01/2017-12/31/2022 were included if they underwent an initial LE endovascular procedure (angioplasty, stenting [all types], or atherectomy) and subsequently had an amputation post-discharge. Patients with amputations likely performed for non-PAD conditions, including trauma or LE malignancy, were excluded. Amputation procedures were categorized as major (ankle or above) or minor (foot/toes). Direct hospital costs during the amputation encounter were quantified and inflation-adjusted to 2024 USD. Analyses were conducted overall and stratified by diabetes, chronic kidney disease (CKD), and chronic limb-threatening ischemia (CLTI).
RESULTS: A total of 38,627 patients were identified (mean age=65.0, mean Charlson Comorbidity Index=0.97). The mean (standard deviation [SD]) hospital cost was $38,060 ($39,934) for major amputations and $25,142 ($34,198) for minor amputations; corresponding median (interquartile range [IQR]) values were $26,831 ($15,695-$46,969) and $16,750 ($6,935-$32,818), respectively. For major amputations, mean and median costs were higher among diabetes (+$4,820 and +$3,695) and CKD patients (+$6,669 and +$5,149, all p<0.01), but lower among CLTI patients (−$2,047, p=0.017; −$1,137, p<0.01) versus patients without these conditions. For minor amputations, mean and median costs were higher in patients with diabetes (+$1,051, p=0.016 and +$638, p<0.01) and CKD (+$4,267 and +$3,023, both p<0.01). Minor amputation costs did not differ significantly by CLTI.
CONCLUSIONS: Hospital costs of LE amputations following endovascular intervention for PAD are substantial, particularly among diabetes or CKD patients. These findings underscore the economic value of preventing progression to amputation through earlier intervention, optimized PAD management, and timely limb-salvage interventions.
METHODS: A retrospective cost analysis was conducted using the Premier PINC AI™ Healthcare Database. Adults aged 18+ with a PAD diagnosis from 01/01/2017-12/31/2022 were included if they underwent an initial LE endovascular procedure (angioplasty, stenting [all types], or atherectomy) and subsequently had an amputation post-discharge. Patients with amputations likely performed for non-PAD conditions, including trauma or LE malignancy, were excluded. Amputation procedures were categorized as major (ankle or above) or minor (foot/toes). Direct hospital costs during the amputation encounter were quantified and inflation-adjusted to 2024 USD. Analyses were conducted overall and stratified by diabetes, chronic kidney disease (CKD), and chronic limb-threatening ischemia (CLTI).
RESULTS: A total of 38,627 patients were identified (mean age=65.0, mean Charlson Comorbidity Index=0.97). The mean (standard deviation [SD]) hospital cost was $38,060 ($39,934) for major amputations and $25,142 ($34,198) for minor amputations; corresponding median (interquartile range [IQR]) values were $26,831 ($15,695-$46,969) and $16,750 ($6,935-$32,818), respectively. For major amputations, mean and median costs were higher among diabetes (+$4,820 and +$3,695) and CKD patients (+$6,669 and +$5,149, all p<0.01), but lower among CLTI patients (−$2,047, p=0.017; −$1,137, p<0.01) versus patients without these conditions. For minor amputations, mean and median costs were higher in patients with diabetes (+$1,051, p=0.016 and +$638, p<0.01) and CKD (+$4,267 and +$3,023, both p<0.01). Minor amputation costs did not differ significantly by CLTI.
CONCLUSIONS: Hospital costs of LE amputations following endovascular intervention for PAD are substantial, particularly among diabetes or CKD patients. These findings underscore the economic value of preventing progression to amputation through earlier intervention, optimized PAD management, and timely limb-salvage interventions.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE1
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)