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The Economic Value of Specialized Lower-Extremity Medical Care by Podiatric Physicians in the Treatment of Diabetic Foot Ulcers

Ginger S. Carls Health Outcomes, Thomson Reuters, Ann Arbor, MI.

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Teresa B. Gibson Health Outcomes, Thomson Reuters, Ann Arbor, MI.

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Vickie R. Driver Department of Surgery, Boston Medical Center and Boston University School of Medicine, Boston, MA.

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James S. Wrobel Center for Lower Extremity Ambulatory Research, Rosalind Franklin University, North Chicago, IL.

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Matthew G. Garoufalis American Podiatric Medical Association, Bethesda, MD.

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Roy R. DeFrancis Independent consultant, Cheektowaga, NY.

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Shaohung Wang Health Outcomes, Thomson Reuters, Ann Arbor, MI.

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J. Erin Bagalman Health Outcomes, Thomson Reuters, Ann Arbor, MI.

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James R. Christina Scientific Affairs, American Podiatric Medical Association, Bethesda, MD.

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Background: We sought to examine the economic value of specialized lower-extremity medical care by podiatric physicians in the treatment of diabetic foot ulcers by evaluating cost outcomes for patients with diabetic foot ulcer who did and did not receive care from a podiatric physician in the year before the onset of a foot ulcer.

Methods: We analyzed the economic value among commercially insured patients and Medicare-eligible patients with employer-sponsored supplemental medical benefits using the MarketScan Databases. The analysis consisted of two parts. In part I, we examined cost or savings per patient associated with care by podiatric physicians using propensity score matching and regression techniques; in part II, we extrapolated cost or savings to populations.

Results: Matched and regression-adjusted results indicated that patients who visited a podiatric physician had $13,474 lower costs in commercial plans and $3,624 lower costs in Medicare plans during 2-year follow-up (P < .01 for both). A positive net present value of increasing the share of patients at risk for diabetic foot ulcer by 1% was found, with a range of $1.2 to $17.7 million for employer-sponsored plans and $1.0 to $12.7 million for Medicare plans.

Conclusions: These findings suggest that podiatric medical care can reduce the disease and economic burdens of diabetes. (J Am Podiatr Med Assoc 101(2): 93–115, 2011)

Corresponding author: Teresa B. Gibson, PhD, Health Outcomes, Thomson Reuters, 777 E Eisenhower Pkwy, Ann Arbor, MI 48108. (E-mail: teresa.gibson@thomsonreuters.com)