Losing a foot versus losing a dollar; a systematic review of cost studies in diabetic foot complications

Abstract

Diabetes mellitus is a chronic disease with high prevalence worldwide and a range of serious related complications. Amongst them, diabetic foot is one of the most disabling, posing a substantial health and economic burden on patients and healthcare systems. Areas covered: According to projections, the expected lower limb morbidity is about to increase - in this light the present review aimed at identifying cost-of-illness studies on the management and treatment of conditions related to the diabetic foot, in an aim to provide a body of evidence for an increasing health care burden. Expert commentary: Recent literature review surfaced a plethora of cost studies. Despite heterogeneity of foot complications and geographic variations, the search methodology revealed substantial costs and further healthcare burden for people with diabetes. Amputations due to suboptimally treated foot infections contribute to the already high rates of hospitalizations and readmissions. The cost of amputation ranges between $35,000 and $45,000 in the developed countries, however it largely depends on the amputation type. Moreover, the findings suggest that the cost of amputation in the US is generally higher compared to the cost in European countries. The cost of amputation in developing countries is substantially lower, as it approximates $5,000.

Effectiveness of multidisciplinary care teams in reducing major amputation rate in adults with diabetes: A systematic review & meta-analysis

“…The authors concluded that both interventions were costly and a MCT itself costs twice as much as an amputation in the country, suggesting neither technique was worthwhile compared to current standard of care practices. This result is reminiscent of Petrakis et al [25], who demonstrated in his systematic review that the cost of amputation was much higher in developed countries ($35,000-$45,000) compared to developing countries ($5000). Cavanagh et al [26] echoed a similar result, where the United States' cost burden from diabetes was significantly higher than developing countries.…”

The cost of diabetic foot ulcers and amputations to the National Health Service in England

“…Recent systematic reviews point to high and increasing costs for diabetic foot disease in many countries, though the levels of cost vary considerably . These differences are likely to arise not only from study and population heterogeneity, but also from variation in patterns of care and cost structures.…”

Resurgence of Diabetes-Related Nontraumatic Lower-Extremity Amputation in the Young and Middle-Aged Adult U.S. Population

“…For women and older adults, amputation rates have flattened after having decreased in prior years. These changes in trend are concerning because of the disabling and costly consequences of NLEAs as well as what they may mean for the direction of efforts to reduce diabetes-related complications (4,16,17).…”