The Sage Group

According To THE SAGE GROUP Peripheral Artery Disease (PAD)-Related Amputations Are Costly For The Economy, The Hospital And The Patient

August 19, 2013 (BUSINESS WIRE) –At the opening session of the 3rd annual Amputation Prevention Symposium (AMP) in Chicago, Mary L. Yost, President of THE SAGE GROUP, delivered a lecture titled “Amputation Is It Really Cost-Effective.”

“Amputation for critical limb ischemia (CLI) is not cost-effective,” stated Yost. “The most recent cost-effectiveness analysis demonstrated that amputation was less cost-effective than either surgical or endovascular revascularization,” she continued.

“Despite being less cost-effective than revascularization, 65,000-70,000 major amputations (above-the-knee and below-the-knee) are performed annually for CLI. The annual cost exceeds $10 billion. Medicare and Medicaid pay almost 80% of the bill,” Ms. Yost explained.

Elaborating on the macroeconomic cost of amputation Yost continued, “This represents a misallocation of scarce healthcare resources as well as a waste of taxpayer dollars.”

“It is commonly believed that amputation costs the hospital less than revascularization procedures. This is incorrect,” declared Ms. Yost. “Published research, as well as our own analysis, demonstrates that amputation actually costs the hospital more than either surgical bypass or endovascular revascularization. Although initial procedure costs are similar, total amputation costs including the costs of in-hospital mortality, morbidity and revision procedures are higher than those of either bypass or endovascular.”

With regard to patient costs associated with amputation, Yost stated, “these costs are significant and include lost wages of the patient and family caregiver, copayments and deductibles and modifications for disabled living such as handrails, wheelchair ramps and wheelchair accessible transportation.”

“The costs are not just monetary. Major amputation is frequently a tragedy for patients and their families. In-hospital morbidity and mortality is high. Above-knee and below-knee amputations are two of the top 5 surgical procedures with the highest perioperative mortality,” she explained.

Commenting on post-discharge patient outcomes Yost continued, “For those surviving the procedure, outcomes and quality of life after amputation are dismal. Most amputees undergo a lengthy healing process, 35% experience depression and almost all suffer from chronic pain as well as perceive themselves to be severely physically impaired. Sixty to 80% cannot walk; contralateral amputation occurs in 36%-50% and at 2 years mortality is 30%-50%.”

PAD, also known as peripheral vascular disease (PVD) is characterized by a reduction of blood flow to the lower limbs due to atherosclerosis. In CLI, the most severe and deadly form of PAD, blood flow is so inadequate that rest pain, ulcerations or gangrene occur. Within 5 years, approximately 70% of CLI patients die. This mortality rate exceeds that of coronary artery disease, breast cancer and colorectal cancer.

THE SAGE GROUP, a research and consulting company, specializes in atherosclerotic disease in the lower limbs, specifically PAD, CLI, ALI (Acute Limb Ischemia), diabetic foot ulcers (DFU) and amputation. The most recent research focuses on quantifying the economic and social costs of PAD and amputation.

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