August 23, 2013 — At the opening session of the third 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,” said Yost. “The most recent cost-effectiveness analysis demonstrated that amputation was less cost-effective than either surgical or endovascular revascularization.
“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 percent of the bill.
“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 said, “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 five surgical procedures with the highest perioperative mortality,” she explained.
Commenting on post-discharge patient outcomes Yost said, “For those surviving the procedure, outcomes and quality of life after amputation are dismal. Most amputees undergo a lengthy healing process, 35 percent experience depression, and almost all suffer from chronic pain as well as perceive themselves to be severely physically impaired. Sixty to 80 percent cannot walk; contralateral amputation occurs in 36-50 percent and at two years mortality is 30-50 percent.”
Peripheral artery disease (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 five years, approximately 70 percent of CLI patients die. This mortality rate exceeds that of coronary artery disease, breast cancer and colorectal cancer.
For more information: www.thesagegroup.us