Counting the cost of preventable diabetes-related lower limb amputations at a single district hospital in KwaZulu-Natal: what does this mean, what can be done?

Abstract

Background: Healthcare policy decisions are driven by many factors, including cost, hence the need to show costs of diabetes mellitus-related lower limb amputations (DMLLA) to inform amendments to health care. Substantial decreases in amputation rates are associated with specialised podiatry foot clinics and ongoing foot education, as per national guidelines on the multidisciplinary team approach (MDTA) to diabetes health care. There are only two podiatry posts in KwaZulu-Natal (KZN) state health department (DoH). Objectives: Aims were to draft the medical costs for 660 DMLLA at Greys Hospital for the period 2013-2017; to extrapolate costs on annual DMLLA in KZN; to outline socio-economic costs for future investigation; to present evidence that podiatry in the MDTA can decrease numbers of DMLLA. Methods: A retrospective review on clinical data captured in real time and maintained by the Pietermaritzburg Metropolitan Trauma Service (PMTS) and Surgical Service (PMSS) was performed. Costs were analysed on data for 660 patients' DMLLA at Greys Hospital between 2013 and 2017, and psychological and socio-economic costs via literature review. Results: Medical care at Greys Hospital for 660 DMLLA in the five years cost in excess of ZAR 213 million. Extrapolated to the 1 231 diabetic amputations ( 2014) equals an annual cost to KZN DoH in excess of ZAR 398 million. Personal, family loss and socio-economic costs are estimated in excess of ZAR five million per amputee, resulting in further cost of ZAR 6.155 billion per annum to KZN. Extrapolation across 11 provinces signifies a national cost of at least ZAR 68 billion. Conclusions: We present a gauge of the cost of DMLLA to KZN and national health. Substantial possible socio-economic losses compound these. The role of podiatrists within MDTA teams has an evidence base to prevent DMLLA.

Clinical and Economic Assessment of MyDiaCare, Digital Tools Combined With Diabetes Nurse Educator Support, for Managing Diabetes in South Africa: Observational Multicenter, Retrospective Study Associated With a Budget Impact Model

“…The analysis incorporated direct medical costs associated with health care visits, tests, and investigations. The unit costs for the health care resources used (health care visits, tests, and investigations) were established from The National Health Reference Price List (NHRPL) [ 26 ], from the literature [ 13 , 27 , 28 ], and from interviews with the key opinion leaders. The unit costs were reported in different years.…”

“…These costs were therefore inflated to 2021 values using the medical inflation rates from Statistics South Africa [ 29 ]. Similarly, the costs of diabetes complications were obtained from the literature and inflated [ 13 , 27 , 28 ].…”

“…In comparison, in the global DISCOVER study, mean HbA 1c was 8.3% at baseline [ 11 ]. It is well established that suboptimal treatment increases the risk of diabetes complications [ 4 ], reduces quality of life [ 12 ], and increases the economic burden [ 13 ].…”

The dysmorphic metatarsal parabola in diabetes—clinical examination and management: a narrative review

“…[1][2][3] Prevention of plantar foot ulceration is paramount, to prevent lower limb amputations and reduce the resultant socioeconomic burden. 4,5 Global and local guidelines on the management of diabetes note that callus formation develops in response to pressure and/or friction and should be referred to a podiatrist or specialist foot team for removal, investigation of aetiology and prevention of recurrence. [4][5][6][7][8][9] Foot posture is important in diabetes, particularly as the person with diabetes complicated by peripheral neuropathy may present with motor neuropathy in addition to sensory neural deficits.…”

“…4,5 Global and local guidelines on the management of diabetes note that callus formation develops in response to pressure and/or friction and should be referred to a podiatrist or specialist foot team for removal, investigation of aetiology and prevention of recurrence. [4][5][6][7][8][9] Foot posture is important in diabetes, particularly as the person with diabetes complicated by peripheral neuropathy may present with motor neuropathy in addition to sensory neural deficits. Examination of anatomical components of the foot can offer insight into the architecture that enables or disables the load-bearing and balancing function of the human foot.…”