In Honor of National Peripheral Artery Disease (PAD) Awareness Month, THE SAGE GROUP Comments on the Costs and Consequences of the Amputation Lottery

It is commonly believed that amputation costs the hospital less than revascularization procedures.

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Tuesday, September 14, 2021
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Summary
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  • It is commonly believed that amputation costs the hospital less than revascularization procedures.
  • 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.
  • Treatment with MA (above-the-knee amputation or below-the-knee amputation) rather than revascularization significantly increases the economic burden of critical limb ischemia (CLI).
  • THE SAGE GROUP, a research and consulting company, specializes in peripheral vascular disease, including venous disease, PAD and CLI, as well as the economic costs of these diseases.


According to, Mary L. Yost, President of THE SAGE GROUP, “The probability of undergoing major amputation (MA) depends on who you are, and where you live, ‘The Amputation Lottery.’ Amputation rates vary by race, socioeconomic status, age, sex, type of hospital and geographic location.”

“Amputation is extremely undesirable for the patient, the payers and the economy. This reflects high costs, lower cost-effectiveness than revascularization and abysmal patient outcomes,” emphasized Yost.

“It is commonly believed that amputation costs the hospital less than revascularization procedures. This is incorrect,” explained Ms. Yost. “Our analysis, as well as other research, demonstrates that MA 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.”

“Amputation for CLI is not cost-effective,” stated Ms. Yost. “Recent cost-effectiveness analyses demonstrate that amputation is less cost-effective than either surgical or endovascular revascularization.”

“Treatment with MA (above-the-knee amputation or below-the-knee amputation) rather than revascularization significantly increases the economic burden of critical limb ischemia (CLI). Major amputations cost $12 billion. Medicare and Medicaid pay almost 80% of the bill. Since the procedure is not cost-effective, this represents a misallocation of scarce healthcare resources and a waste of taxpayer dollars,” declared Ms. Yost.

“Direct medical costs represent only part of the bill. Estimated lifetime medical and non-medical costs exceed $11 billion for a total cost of $23 billion. Almost three-quarters of these expenses are non-medical, and most are not reimbursed. Consequently, they are borne directly by the patient and family,” she continued.

“With earlier diagnosis and treatment these costs could be avoided,” Yost explained. “The Amputation Reduction and Compassion Act (ARC), which was recently reintroduced in Congress, includes provisions that change amputation reimbursements requiring appropriate diagnostic testing prior to amputation, as well as provisions for PAD screening and education.”

THE SAGE GROUP, a research and consulting company, specializes in peripheral vascular disease, including venous disease, PAD and CLI, as well as the economic costs of these diseases.

Additional information: www.thesagegroup.us.

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