Geographic variations in US diabetic foot expenditure identified

By Lauretta Ihonor, medwireNews reporter

Researchers report that in the USA, Medicare spending on patients with diabetic foot disease varies significantly between different hospital referral regions.

Mortality rates among these patients also appear to vary with geographic region, write the authors in the Journal of Diabetes Complications.

But, contrary to expectations, higher Medicare spending is not associated with significant reductions in 1-year mortality among diabetic patients with foot disease, say Michael Sargen (University of Pennsylvania Perelman School of Medicine, Philadelphia, USA) and team.

They add: "Unidentified factors are likely contributing to higher costs and decreased survival in certain parts of the country.

"Possible explanatory factors to explain geographic variation in spending and mortality would be patient compliance with treatment regimens, access to care, and local provider management styles such pharmacotherapy decisions."

The researchers assessed data on 682,887 diabetic Medicare beneficiaries with foot ulcers and 151,752 beneficiaries with lower extremity amputations.

They found that per capita healthcare spending for patients with foot ulcers (mean US$ 31,363 [€ 24,085]) and lower extremity amputations (mean $ 48,354 [€ 37,133]) was higher than for diabetic patients without these complications (mean $ 11,692 [€ 8979]).

The exact amount spent on healthcare for these patients "varied considerably across the nation for our two patient cohorts," say the researchers.

Macrovascular complications were positively associated with mortality rates among amputees, but not among foot ulcer patients.

Rates of macrovascular complication also showed positive association with per capita spending among patients with foot ulcers.

And among diabetic patients with either type of foot disease complication, hospital admission rates were positively associated with per capita spending and mortality.

The researchers highlight that the current associations identified between Medicare spending, mortality, and hospital admission rates are also likely to exist among diabetic patients without foot disease.

But "further studies are required to confirm this hypothesis," say Sargen and team.

They conclude: "Although beneficiaries with foot ulcers and amputations represent only 10.0% of all diabetic Medicare beneficiaries, they are very expensive to treat accounting for 24.4% of total healthcare expenditures for this diabetic population."

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