PMD6 Marginal Cost of Lower-LIMB Amputation in Germany

Abstract

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. 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). 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. 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.