OBJECTIVE -Peripheral neuropathy is common among people with diabetes and can result in foot ulceration and amputation. The aim of this study was to quantify the annual medical costs of peripheral neuropathy and its complications among people with type 1 and type 2 diabetes in the U.S. RESEARCH DESIGN AND METHODS-A cost-of-illness model was used to estimate the numbers of diabetic individuals in the U.S. who have diabetic peripheral neuropathy (DPN) and/or neuropathic foot ulcers (both those with no deep infection and those accompanied by cellulitis or osteomyelitis) at a given point in time, and/or a toe, foot, or leg amputation during a year. Prevalence and incidence rates were estimated from published studies and applied to the general U.S. population. All costs were estimated in 2001 U.S. dollars. In a sensitivity analysis, we varied the rates of complications to assess the robustness of the cost estimates.RESULTS -The annual costs of DPN and its complications in the U.S. were $0.8 billion (type 1 diabetes), $10.1 billion (type 2 diabetes), and $10.9 billion (total). After allowing for uncertainty in the point estimates of complication rates, the range of costs were between $0.3 and $1.0 billion (type 1 diabetes), $4.3b and $12.7 billion (type 2 diabetes), and $4.6 and $13.7 billion (type 1 and type 2 diabetes).CONCLUSIONS -The total annual cost of DPN and its complications in the U.S. was estimated to be between $4.6 and $13.7 billion. Up to 27% of the direct medical cost of diabetes may be attributed to DPN. Diabetes Care 26:1790 -1795, 2003D iabetic peripheral neuropathy (DPN) is a particularly debilitating complication of diabetes and accounts for significant morbidity by predisposing the foot to ulceration and lower extremity amputation. It is estimated that between 12 and 50% of people with diabetes have some degree of DPN (1), which may be asymptomatic or symptomatic. Symptoms may be disabling and are manifested as "positive" symptoms, including numbness, prickling, pain (e.g., burning, lancinating, aching), or allodynia. A predominant feature of DPN is sensory loss, which may lead to foot ulceration due to even minor trauma.Approximately 15% of people with diabetes develop at least one foot ulcer during their lifetime (2-8), and while vascular disease leading to ischemia is certainly a factor in the pathogenesis, 60 -70% of diabetic foot ulcers are primarily neuropathic in origin (3). Deep foot ulcers may be accompanied by cellulitis or osteomyelitis, and a severely infected or nonhealing foot ulcer may lead to an amputation of the toe, foot, or leg.In the U.S., the annual total direct medical and treatment cost of diabetes was estimated to be $44 billion in 1997, representing 5.8% of total personal health care expenditure in the U.S. during that year (9). The management of DPN and its complications is likely to form a large proportion of this total expenditure, because treatment is often resource intensive and long term.The aim of this cost of illness study was to quantify the annual health care cos...

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Introducing STTPs as standard treatment for people with Type 1 diabetes in the UK may help to achieve the primary goal of the National Service Framework (NSF) for Diabetes by enabling individuals to manage their own lifestyle and condition. In doing so it could save valuable resources for the NHS and yield important morbidity and mortality gains.