Impact of Diabetes on Medical Costs in the Pre- and Postoperative Year of Lower Extremity Amputations in Belgium

Aims: To compare the medical costs of individuals undergoing lower extremity amputation (LEA) in Belgium with those of amputation-free individuals. Methods: Belgian citizens undergoing LEAs in 2014 were identified. The median costs per capita in euros for the 12 months preceding and following minor and major LEAs were compared with those of matched amputationfree individuals. Results: A total of 3324 Belgian citizens underwent LEAs (2295 minor, 1029 major), 2130 of them had diabetes. The comparison group included 31,716 individuals. Amputation was associated with high medical costs (individuals with diabetes: major LEA euro49,735, minor LEA euro24,243, no LEA euro2,877 in the year preceding amputation; euro45,740, euro21,445 and euro2,284, respectively, in the post-amputation year). Significantly higher costs were observed in the individuals with (versus without) diabetes in all groups. This difference diminished with higher amputation levels. Individuals undergoing multiple LEAs generated higher costs (individuals with diabetes: euro39,313-euro89,563 when LEAs preceded index amputation; euro46,629-euro92,877 when LEAs followed index amputation). Individuals dying in the year after a major LEA generated remarkably lower costs. Conclusions: LEA-related medical costs were high. Diabetes significantly impacted costs, but differences in costs diminished with higher amputation levels. Individuals with multiple amputations generated the highest costs.