Economic Burden of Foot and Ankle Surgery in the US Medicare Population

Background: Musculoskeletal diseases affecting the foot and ankle are common and can result in debilitating pain and chronic disability. The purpose of this study was to estimate the economic burden associated with operative interventions targeting these afflictions in the Medicare population. Methods: Procedure incidence was determined using data from Medicare Part B National Summary Data Files (for 2000-2011). Health care and productivity costs were estimated for each year using an incidence-based cost model, using demographic information from 10 633 patient encounters at the University of Iowa Hospitals and Clinics over the period January 1, 2000, to December 31, 2010. Results: The estimated economic burden of foot and ankle surgery in the Medicare population was $11 billion in 2011, up 38.2% since 2000. Direct health care costs were responsible for only 11% of this total, while indirect productivity costs contributed the remainder. Procedures targeting the foot accounted for over two-thirds of total economic burden, or $7.6 billion. Treatments for fracture and dislocation contributed the most to overall economic burden (31.0% of total), followed by reconstructive procedures (30.7%) and amputations (13.3%). Conclusion: Even in an older population, considerable productivity losses are associated with foot and ankle surgery. An increasing share of the population older than 65 expects to be fit to work, making disability in older Americans more monetarily important. At the same time, trends in chronic disease mean that the incidence of foot and ankle problems is likely to increase in the Medicare population. Level of Evidence: Level III, economic analysis.