Background: Recent reports have suggested that functional outcomes
are similar following either amputation or reconstruction of a severely
injured lower extremity. The goal of this study was to compare two-year direct
health-care costs and projected lifetime health-care costs associated with
these two treatment pathways.
Methods: Two-year health-care costs were estimated for 545 patients
with a unilateral limb-threatening lower-extremity injury treated at one of
eight level-I trauma centers. Included in the calculation were costs related
to (1) the initial hospitalization, (2) all rehospitalizations for acute care
related to the limb injury, (3) inpatient rehabilitation, (4) outpatient
doctor visits, (5) outpatient physical and occupational therapy, and (6)
purchase and maintenance of prosthetic devices. All dollar figures were
inflated to constant 2002 dollars with use of the medical service Consumer
Price Index. To estimate projected lifetime costs, the number of expected life
years was multiplied by an estimate of future annual health-care costs and
added to an estimate of future costs associated with the purchase and
maintenance of prosthetic devices.
Results: When costs associated with rehospitalizations and
post-acute care were added to the cost of the initial hospitalization, the
two-year costs for reconstruction and amputation were similar. When
prosthesis-related costs were added, there was a substantial difference
between the two groups ($81,316 for patients treated with reconstruction and
$91,106 for patients treated with amputation). The projected lifetime
health-care cost for the patients who had undergone amputation was three times
higher than that for those treated with reconstruction ($509,275 and $163,282,
respectively).
Conclusions: These estimates add support to previous conclusions
that efforts to improve the rate of successful reconstructions have merit. Not
only is reconstruction a reasonable goal at an experienced level-I trauma
center, it results in lower lifetime costs.
Level of Evidence: Economic and decision analysis, Level
II. See Instructions to Authors for a complete description of levels of
evidence.