Who's Really Footing the Bill? Sex and Ethnicity Disparities in the Cost of Diabetic Foot Ulcer-Related Amputations in a Major Healthcare System.

Abstract

Diabetic foot ulcers (DFU)-related amputations are associated with enormous expenditures. Understanding why amputation services are more expensive for certain patients is crucial for reforming healthcare expenditure and insurance practices. This analysis examined differences in cost of DFU-related amputations services in patients insured by HealthFirst, a Medicaid-managed insurance company. Data from HealthFirst were collected for patients admitted for DFU-related amputation between 2021-2023. Demographics and laboratory values were extracted from the electronic health record. Demographics, laboratory values, total costs, and paid amounts were analyzed. Clinical variables were tested as predictors of expenditure levels through bivariate analysis. In our cohort of 140 patients, 65.3% of patients were male, with a mean age of 60.6 (S.D. 12) years, diagnosis of type 2 diabetes (96.3%) and ethnically Hispanic-Latino (56.1%). Common comorbidities were chronic kidney disease (57.9%) and hypertension (86.2%). DFU- related amputation charges were higher for Hispanic-Latino individuals, RR 1.97 (CI 1.04, 3.71), and those with chronic kidney disease, RR 1.36 (CI 1.0, 1.86) and moderately associated with female sex. Serum glucose, RR 1 (1.0 -1.0), body mass index, RR 0.98 (0.96-1.0), and Hemoglobin A1c, RR 1.01 (CI 0.93-1.09) were not found to be associated with higher cost. Overall, Hispanic-Latino individuals, persons with chronic kidney disease, and women incurred higher DFU related charges, highlighting the need for heightened DFU prevention in these populations. Level of Clinical Evidence: Retrospective cohort study= 2 or 3.