Diabetes mellitus is a significant illness, both from an
individual point of view and a societal perspective. According
to the Centers for Disease Control and Prevention in 2007,
the number of people in the United States (U.S.) with diabetes
mellitus reached 24 million, with another 57 million people
estimated to have prediabetes.1 From 1980 to 2008, the
number of diabetic Medicare beneficiaries aged 65 or older
increased from 2.3 million to 7.4 million.2 In a population of
beneficiaries with at least 12 months of continuous enrollment
in Medicare Parts A and B fee-for-service (FFS) in 2008, 8.9
million all-age Medicare beneficiaries had diabetes mellitus,
or nearly 28 percent of this cohort.3 The actual national cost
burden of diabetes is thought to exceed $174 billion, including
the social cost of intangibles such as pain and suffering, care
provided by nonpaid caregivers, medical costs associated with
undiagnosed diabetes, and diabetes-attributed costs.4 On
average, medical expenditures are thought to be 2.3 times
higher in people with diabetes as compared to those without
diabetes.4 Many of these expenditures are likely related to
comorbidities associated with diabetes like diabetic foot ulcer
(DFU) and lower extremity amputation (LEA).
Common complications of diabetes are foot ulcer and LEA.
These complications can have dramatic effects on the patient’s
health and general well being and can be expensive to treat.
For example, in 2001, diabetes-related foot ulcers and amputations
were estimated to cost U.S. health care payers $11
billion.5 Although much effort has been made to determine
cost-effectiveness of the care of diabetic individuals with foot
ulceration and those who require LEA, questions remain as
to whether interventions such as hyperbaric oxygen therapy,
negative pressure wound therapy, and specialized dressing
materials are really beneficial. Concern for cost-effectiveness
has also spurred interest in trying to better understand the
potential benefits, if any, of special-needs programs that
may be able to provide quality care in an effective
and efficient manner for diabetic patients.6
Beneficiaries with a diabetic foot
ulcer are seen by their outpatient
health care provider about 14 times
per year and are hospitalized about
1.5 times per year. The cost of care
for these beneficiaries is substantial,
at about $33,000 for total reim-bursement of all Medicare services
per year.
Beneficiaries with a lower extremity amputation are seen by their out-patient health care provider about
12 times per year and are hospital- ized about 2 times per year. The
cost of care for these beneficiaries
is substantial, at about $52,000 for total reimbursement of all Medicare services per year.
Diabetes mellitus is a significant illness, both from an
individual point of view and a societal perspective. According
to the Centers for Disease Control and Prevention in 2007,
the number of people in the United States (U.S.) with diabetes
mellitus reached 24 million, with another 57 million people
estimated to have prediabetes.1 From 1980 to 2008, the
number of diabetic Medicare beneficiaries aged 65 or older
increased from 2.3 million to 7.4 million.2 In a population of
beneficiaries with at least 12 months of continuous enrollment
in Medicare Parts A and B fee-for-service (FFS) in 2008, 8.9
million all-age Medicare beneficiaries had diabetes mellitus,
or nearly 28 percent of this cohort.3 The actual national cost
burden of diabetes is thought to exceed $174 billion, including
the social cost of intangibles such as pain and suffering, care
provided by nonpaid caregivers, medical costs associated with
undiagnosed diabetes, and diabetes-attributed costs.4 On
average, medical expenditures are thought to be 2.3 times
higher in people with diabetes as compared to those without
diabetes.4 Many of these expenditures are likely related to
comorbidities associated with diabetes like diabetic foot ulcer
(DFU) and lower extremity amputation (LEA).
Common complications of diabetes are foot ulcer and LEA.
These complications can have dramatic effects on the patient’s
health and general well being and can be expensive to treat.
For example, in 2001, diabetes-related foot ulcers and amputations
were estimated to cost U.S. health care payers $11
billion.5 Although much effort has been made to determine
cost-effectiveness of the care of diabetic individuals with foot
ulceration and those who require LEA, questions remain as
to whether interventions such as hyperbaric oxygen therapy,
negative pressure wound therapy, and specialized dressing
materials are really beneficial. Concern for cost-effectiveness
has also spurred interest in trying to better understand the
potential benefits, if any, of special-needs programs that
may be able to provide quality care in an effective
and efficient manner for diabetic patients.6
Beneficiaries with a diabetic foot
ulcer are seen by their outpatient
health care provider about 14 times
per year and are hospitalized about
1.5 times per year. The cost of care
for these beneficiaries is substantial,
at about $33,000 for total reim-bursement of all Medicare services
per year.
Beneficiaries with a lower extremity amputation are seen by their out-patient health care provider about
12 times per year and are hospital- ized about 2 times per year. The
cost of care for these beneficiaries
is substantial, at about $52,000 for total reimbursement of all Medicare services per year.