Cost of lower-limb amputation in U.S. veterans with diabetes using health services data in fiscal years 2004 and 2010

J Rehabil Res Dev. 2014;51(8):1325-30. doi: 10.1682/JRRD.2013.11.0249.


The purpose of this study was to estimate healthcare costs associated with diabetes-related lower-limb amputations (LLAs) within the Veterans Health Administration (VHA). We performed a cross-sectional comparative analysis of 3,381 VHA clinic users in fiscal year (FY) 2004 and 3,403 clinic users in FY2010 identified as having type 2 diabetes mellitus and nontraumatic LLA. LLA expenditures related to inpatient medical, inpatient surgical, and outpatient care were estimated using VHA Health Economics Resource Center average cost files. LLA-related pharmaceutical costs were obtained from VHA Decision Support System national extract files. From the Department of Veterans Affairs (VA) perspective, the mean cost associated with care for diabetes-related LLA per patient in the VA healthcare system in FY2004 was $50,351 (95% confidence interval [CI] = 48,939-51,803) in U.S. dollars; the total cost for all 3,381 patients was $170,236,037. In FY2010, cost per patient rose to $60,647 (95% CI = 59,143-62,188), with a total cost of $206,380,331 for 3,403 patients. In the VHA healthcare system, the economic burden associated with LLAs in patients with diabetes exceeded $200,000,000 in FY2010. This suggests that further improvements in care of patients with diabetes could be associated with significant cost savings.

Keywords: LLA expenditures; VA; VHA; Veterans Health Administration; amputations; cost; diabetes; health services; lower-limb amputations; veteran.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Amputation / economics*
  • Cross-Sectional Studies
  • Diabetes Complications / economics*
  • Diabetes Complications / surgery*
  • Diabetes Mellitus, Type 2 / complications*
  • Female
  • Health Care Costs / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Time Factors
  • United States
  • Veterans Health / economics*