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Cost of major amputation
The hospitalisation cost of AN-DRG 411 Amputation (21.5 days average length of stay)
is $14,805. 121 In the absence of more precise data for a variety of causes, this DRG cost
is used to approximate the cost of a major amputation. This cost is an average cost for all
types of amputation and may not be an accurate cost for major amputations specifically
associated with diabetes. More precise Australian patient level cost data could be used.
However even these data may be an overestimate of the resources saved by reducing the
number of amputations overall. In some of the studies of HBOT, patients were recruited
from in-patients. In those studies there was some evidence of a reduced length of stay
with HBOT but this was not significant. Attributing the full cost of a hospital stay
involving an amputation (21.5 days in the national casemix data) as a saving with HBOT
may be an overestimate for patients already admitted for a diabetic wound. No
information on the change in resource use associated with a major amputation for
patients admitted as a result of a diabetic wound is available. Such data could only come
from a prospective randomised trial of HBOT in which resource use data were collected.
Major amputations are also expected to incur rehabilitation costs, and these are expected
to increase the costs associated with major amputations. The hospitalisation cost of AN-
DRG 941 Rehabilitation (20 days average length of stay) is $8,758. 121 This may not be an
accurate cost for rehabilitation associated with amputations given the extra cost of
prostheses. However, in the absence of more precise data, this DRG cost is used to
approximate the acute hospitalisation cost of rehabilitation for major amputations. The
costs of rehabilitation after being discharged from hospital have not been included in the
analysis in Tables 77and 78.
An incremental cost-effectiveness analysis with and without cost offsets from
amputations avoided is shown in Table 77.
Table 77 Estimation of incremental cost per major amputation avoided – 100 patients
100 patients Intervention Group Comparison Group Incremental
(HBOT)
(no HBOT)
Incremental treatment costs of
HBOT
$694,105 - $694,105
Major Amputations 20 avoided
Incremental HBOT cost per
amputation avoided
Difference in cost of major
amputation (cost savings)
20 major amputations prevented
$34,705
($296,100)
Difference in cost of
($175,160)
rehabilitation (cost savings)
Net Cost $222,845
Incremental cost per major
$11,142
amputation avoided
There is an argument to limit the analysis to major amputations, on the grounds that only
these were statistically significant in the pooled analysis. As shown in Table 77 if no cost
offsets are considered, the incremental cost per major amputation avoided is estimated as
$34,705. When the cost offsets of major amputations are considered, the incremental
cost per major amputation avoided is $11,142. The analysis in Table 77 only uses the
acute hospitalisation cost of major amputations and rehabilitation. If outpatient
Hyperbaric oxygen therapy 83