Session III - Reconstruction

Thurs., 10/5/06 Reconstruction, Paper #17, 5:00 pm

Two-Year Health Care Costs following Limb Amputation or Reconstruction

Alison Snow-Jones, PhD1 (a-NIH); Ellen J. MacKenzie, PhD2 (a-NIH);
Michael J. Bosse, MD3 (a-NIH); Renan C. Castillo2 (a-NIH); LEAP Study Group;
1Department of Social Science & Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA;
2Center for Injury Research & Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA;
3Carolinas Medical Center, Charlotte, North Carolina, USA

Purpose: Recently published data indicate similar outcomes following amputation or reconstruction of severe lower extremity injury. The goal of this study was to compare the total 2-year health care costs associated with these two treatment pathways.

Methods: Patients (N = 569) with unilateral limb-threatening lower extremity injuries were admitted to 8 US Level I trauma centers, and 545 (95.8%) had sufficient follow-up and billing information to include in this analysis. Data on billed inpatient charges and professional fees associated with the patients' initial hospitalization and all limb-related rehospitalizations were collected directly from the hospitals. Estimates of costs were obtained by multiplying billed charges by Medicare cost-to-charge ratios from each hospital's Medicare Cost Report. Inpatient rehabilitation costs were derived by multiplying length of stay by an average per diem charge obtained from a sample of rehabilitation facilities. Total outpatient medical, physical, and occupational therapy visits were reported by the patient, and per visit cost data were estimated from the Medstat MarketScan®, a proprietary database of claims data from ~4 million insured persons. Prosthetic costs were obtained directly from the patient's prosthetists and confirmed against patient self-report. All estimates are CPI-adjusted and presented in 2002 dollars.

Results: As shown in the table below, there were no significant differences in total 2-year health care costs for amputation or reconstruction patients, although costs were substantially higher for those with multiple trauma as reflected by an Injury Severity Score of 17 or higher.

   N  Mean Total Costs  ISS < 17  ISS > or = 17
 All Patients  545  $84,208  $75,359  $115,887
 Reconstructions  384  $81,316  $73,097  $113,051
 Amputations  161  $91,105  $78,106  $121,357

Among salvage patients, the initial and rehospitalizations accounted for 70% and 15% of costs, respectively. Among amputees, these accounted for 65% and 5% of costs, respectively. Among amputees, prosthetic devices accounted for 14% of costs. For both treatment groups, rehabilitation and outpatient medical services accounted for 14% and 5% of costs, respectively.

Conclusions: The results show comparable 2-year health care costs associated with amputation or reconstruction following severe lower extremity trauma. Reconstruction patients had higher hospitalization costs, but these differences were offset by prosthetic costs among amputees. Given the frequency with which prostheses need replacement, it is reasonable to assume that total lifetime costs associated with amputation will be higher than those associated with reconstruction. Further studies are underway to model these lifetime costs.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.