A study completed by the Minnesota Department of Health and the University of Minnesota (UM), Minneapolis, found that the incidence of amputations resulting from critical limb ischemia (CLI), the most severe manifestation of peripheral artery disease (PAD), is high and results in high health economic costs.
The study, which reviewed all inpatient discharge claims in Minnesota from 2005 through 2008 using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedure codes for lower-limb amputation not due to trauma or cancer, found the median total charge for more than 4,300 hospitalizations for lower-limb amputations due to CLI during that period to be $32,129.The cumulative inpatient hospitalizations charges totaled $56.5 million in 2008.
The study found that amputations increased significantly with age, were more common in men and in people with diabetes, and were slightly more common in people who lived in rural areas. People with PAD may be asymptomatic but often experience limping as the primary ischemic symptom that causes leg muscle pain with movement. When atherosclerotic artery blockages in the leg progress and become severe or when a clot travels to completely block a leg artery, unremitting ischemia at rest can occur. This presentation of PAD is defined as CLI and signifies an imminent risk of amputation if revascularization is not achieved. The etiology of more than 80 percent of amputations that occur in all developed nations, including those that occur in people with diabetes, are due to PAD and CLI.
The incidence of CLI will likely increase as the population ages because of the increasing prevalence of diabetes the study projects. If so, these preventable and costly limb ischemic events will demand greater medical and revascularization resources.
According to the study, although Minnesota is home to less than 2 percent of the total U.S. population, and Minnesotans experience lower rates of atherosclerotic disease and lower medical costs than the national average, the results delineate the health cost implications in the context of nationally limited healthcare resources. The methods could be used to model an ischemic amputation surveillance strategy for other states.
This story has been summarized from the report, “The Incidence and Health Economic Burden of Ischemic Amputation in Minnesota,” 2005-2008, www.cdc.gov/pcd/issues/2011/nov/11_0023.htm. Accessed October 24, 2011.
