Higher spending on vascular care did not lower amputation rate

In a study of 18,463 Medicare patients, researchers found increased spending on vascular care was not associated with a lower amputation rate.

Researchers examined the association between regional spending on vascular care in the United States and amputation in regions where Medicare patients underwent amputations related to peripheral artery disease (PAD) from 2003 to 2010.

According to study results, the mean cost of inpatient care the year before amputation was $22,405, varying from $11,077 to $42,613 by region. This included costs related to the amputation procedure itself.

Patients in high-spending regions were more likely to undergo vascular procedures. However, study results showed although revascularization was associated with higher spending, higher spending was not associated with lower regional amputation rates. Researchers also found the regions that had high spending and high amputation rates were the most aggressive in the use of endovascular interventions.

“Medicare spending on patients with severe PAD varies more than two-fold across the United States and the regions where spending is the highest perform the most revascularization procedures in the year prior to amputation,” the researchers concluded. “And although our prior work suggests that access to revascularization is a key component in preventing amputation, our current analysis offers little evidence to suggest that more expensive vascular care offers a marginal advantage over less expensive vascular interventions.”

For more information:

Goodney PP. JAMA Surg. 2013;doi:10.1001/jamasurg.2013.4277.

Disclosure: The researchers have no relevant financial disclosures.

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