The Sage Group

THE SAGE GROUP LLC Announces Publication of an Article Titled “Cost-Benefit Analysis of Amputation in the Era of the Affordable Care Act. Is it Fiscally Responsible to Perform Primary Amputation as Treatment?” in the May Issue of Endovascular Today

ATLANTA, June 2, 2014 (BUSINESS WIRE)—The recently released May issue of Endovascular Today, which focuses on critical limb ischemia, includes an analysis of the economic costs and consequences of major amputations written by Mary L. Yost, President of THE SAGE GROUP.

The article focuses on the continuing use of major amputation as a primary treatment for critical limb ischemia (CLI). Approximately 25%-33% of Medicare CLI patients undergo major amputation (above-the-knee and below-the-knee amputation).

Major amputation is frequently the only treatment that CLI patients undergo. Recent research has shown that 60%-71% of the major amputations are performed without any attempt at revascularization.

“This is completely the opposite of current expert treatment recommendations—at most 10%-15% of CLI patients should have primary amputation and some limb salvage experts recommend none,” stated Ms. Yost.

Although an angiogram has been shown to be highly protective against major amputation, reducing the odds by 90%, approximately 51%-73% of major amputations are performed without this basic diagnostic evaluation.

According to Ms. Yost, “The probability of major amputation depends on who you are and where you live, the ‘Amputation Lottery”. Amputation varies according to race, socioeconomic status, age, sex, type of hospital and geographic location.”

The discussion explores possible reasons for these practices as well as the high costs of amputation in terms of patient mortality and morbidity.

“Amputation is not only extremely undesirable from the patient’s viewpoint it is socially undesirable in terms of costs. CLI amputations cost almost $11 billion,” declared Yost. “Available evidence indicates that treating CLI patients with primary amputation is not cost-effective and represents a misallocation of scarce healthcare resources,” she concluded.

This article can be found on the Endovascular Today website at:


THE SAGE GROUP, a research and consulting company, specializes in atherosclerotic disease in the lower limbs, specifically PAD (Peripheral Artery Disease), CLI (Critical Limb Ischemia) and ALI (Acute Limb Ischemia) as well as ischemic diabetic foot ulcers (DFU). The most recent research focuses on quantifying the economic costs of PAD and PAD-associated amputations.

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