Harrington C, Zagari M J, Corea J, Klitenic J
Lewin Group, Falls Church, Virginia 22042, USA.
Diabetes Care. 2000 Sep;23(9):1333-8. doi: 10.2337/diacare.23.9.1333.
Our objectives were to 1) estimate the prevalence of diabetes and diabetic lower-extremity ulcers in the Medicare population, 2) characterize Medicare population-specific costs for lower-extremity ulcer episodes, and 3) evaluate potential cost savings associated with better healing of lower-extremity ulcers.
Prevalence and costs of diabetic lower-extremity ulcers were obtained by an analysis of Medicare claims data from 1995 and 1996 Standard Analytic Files (5% sample).
Medicare expenditures for lower-extremity ulcer patients were on average 3 times higher than those for Medicare patients in general ($15,309 vs. $5,226). Lower-extremity ulcer-related spending accounted for 24% of total spending for lower-extremity ulcer patients. Most of the ulcer-related costs accrued on the inpatient side (73.7%); proportionately smaller amounts went to physicians and nursing home facilities. To determine the potential effect of better diabetic ulcer management, a model was created that estimated the impact on costs with improved healing rates. Improving the 20-week healing rate from 31 to 40% would save Medicare $189 per episode.
Lower-extremity ulcers cost the Medicare system $1.5 billion in 1995. Any wound care intervention that could prevent even a small percentage of wounds from progressing to the stage at which inpatient care is required may have a favorable cost effect on the Medicare system.
我们的目标是：1）估计医疗保险人群中糖尿病及糖尿病下肢溃疡的患病率；2）描述特定医疗保险人群下肢溃疡发作的费用情况；3）评估与下肢溃疡更好愈合相关的潜在成本节约。
通过分析1995年和1996年标准分析文件（5%样本）中的医疗保险理赔数据，获取糖尿病下肢溃疡的患病率和费用情况。
下肢溃疡患者的医疗保险支出平均比一般医疗保险患者高出3倍（15,309美元对5,226美元）。与下肢溃疡相关的支出占下肢溃疡患者总支出的24%。大部分与溃疡相关的费用产生于住院方面（73.7%）；用于医生和疗养院设施的费用比例相对较小。为确定更好的糖尿病溃疡管理的潜在效果，创建了一个模型，该模型估计了愈合率提高对成本的影响。将20周愈合率从31%提高到40%，每次发作可为医疗保险节省189美元。
1995年，下肢溃疡使医疗保险系统花费15亿美元。任何能够预防哪怕一小部分伤口发展到需要住院治疗阶段的伤口护理干预措施，都可能对医疗保险系统产生有利的成本影响。
