Potential Economic Benefits of Lower-Extremity Amputation Prevention Strategies in Diabetes
- Daniel A Ollendorf, MPH,
- James G Kotsanos, MD, MS,
- William J Wishner, MD,
- Mark Friedman, MD,
- Tamara Cooper, RN, CDE,
- Marisa Bittoni, MS and
- Gerry Oster, PHD
- Policy Analysis Incorporated Brookline, Massachusetts
- Policy Analysis Incorporated Eli Lilly
- Division of Endocrinology and Metabolism, Indiana University School of Medicine Indianapolis, Indiana
- Bittoni Research Columbus, Ohio
- Address correspondence and reprint requests to Dr. James G. Kotsanos, Division of Global Health Economics Research, Eli Lilly and Company, Lilly Corporate Center, Drop Code 2646, Indianapolis, IN 46285. E-mail: kotsanos{at}lilly.com
Abstract
OBJECTIVE To estimate the potential economic benefits of selected strategies from published literature—educational interventions, multidisciplinary clinics, and insurance coverage for therapeutic shoes—to reduce the incidence of lower-extremity amputation among individuals with diabetes.
RESEARCH DESIGN AND METHODS We developed a model to estimate the expected incidence and associated costs of lower-extremity amputation in a hypothetical cohort of 10,000 people with diabetes. Prevention strategies were assumed to be targeted at individuals with a history of foot ulcer, and benefits were estimated over a period of 3 years.
RESULTS The total potential economic benefits (discounted at 5%) of strategies to reduce amputation risk ranged from $2.0 to $3.0 million ($2,900 to $4,442 per person with a history of foot ulcer) over 3 years. Benefits were highest for educational interventions. Most benefits were found to accrue among individuals aged ≥ 70 years.
CONCLUSIONS Strategies to reduce the risk of lower-extremity amputation may generate substantial economic benefits and should be a standard component of routine diabetes care. Benefits may best be achieved through a partnership of government, private payers, health care service providers and producers, and individuals with diabetes.
- Received October 17, 1997.
- Accepted April 15, 1998.
- Copyright © 1998 by the American Diabetes Association











