OBJECTIVES

Lower-limb amputation is an undesired outcome in patients with critical limb ischemia (CLI), majorly impacting quality of life of the patients. In Germany, total no. of ischemic lower-limb amputations remains high, more than 50,000/year, despite availability of guideline recommended therapies at early stages. We calculated the first-year marginal cost of amputation as an additional healthcare expenditure to CLI treatment, imposed only by the amputation, in an average CLI patient from German healthcare system perspective.

METHODS

Major cost-components per amputation and their sources were identified as a) outpatient visits (general practitioner and podiatrist) from the uniform valuation scale (EBM), b) hospital stay (in-patient and nursing) from German Diagnosis-Related Groups (aG-DRG), c) rehabilitation from the literature of German Pension Insurance (DRV), and d) medical aid by adjusting the yearly cost in an earlier study for inflation. The base-costs of EBM were multiplied by assuming 10 outpatient visits, the rehabilitation rate was multiplied by literature-suggested average 3 weeks of stay, and the flat-rates of aG-DRG were multiplied by 14.2 days of average length of stay as provided as in ‘flat-rates per case’ catalog by Institute for the Hospital Renumeration System (InEK).

RESULTS

Average first year costs per amputation for outpatient visits, hospital stay, rehabilitation, and medical aid were 223.00 €, 7,021.87 €, 2,520.00 €, and 9,903.00 € respectively. Average marginal cost of amputation sums up to 19,668.00 € per amputation in the first year of amputation.

CONCLUSIONS

In addition to poor health outcomes and low quality of life due to amputation, the marginal cost of lower-limb amputation, when applied to the total no. of amputations every year, imposes a significant economic burden to German healthcare system. Timely and patient-centric management of CLI may not only save limbs and lives but also reduce amputation-related health-care costs.