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

Abstract

Aim To estimate the healthcare costs of diabetic foot disease in England. Methods Patient‐level data sets at a national and local level, and evidence from clinical studies, were used to estimate the annual cost of health care for foot ulceration and amputation in people with diabetes in England in 2014–2015. Results The cost of health care for ulceration and amputation in diabetes in 2014–2015 is estimated at between £837 million and £962 million; 0.8% to 0.9% of the National Health Service (NHS) budget for England. More than 90% of expenditure was related to ulceration, and 60% was for care in community, outpatient and primary settings. For inpatients, multiple regression analysis suggested that ulceration was associated with a length of stay 8.04 days longer (95% confidence interval 7.65 to 8.42) than that for diabetes admissions without ulceration. Conclusions Diabetic foot care accounts for a substantial proportion of healthcare expenditure in England, more than the combined cost of breast, prostate and lung cancers. Much of this expenditure arises through prolonged and severe ulceration. If the NHS were to reduce the prevalence of diabetic foot ulcers in England by one‐third, the gross annual saving would be more than £250 million. Diabetic foot ulceration is a large and growing problem globally, and it is likely that there is potential to improve outcomes and reduce expenditure in many countries.

The future for diabetic foot ulcer prevention: A paradigm shift from stratified healthcare towards personalized medicine

“…Setting up such collaborations will require significant efforts and resources from all stakeholders involved, especially with individualized diagnostics of the large and continuously growing number of people with diabetes. However, we argue that the current lack of knowledge and current efforts employed are even more expensive, as each ulcer not prevented costs on average about €10,000 per ulcer episode in medical costs alone, with the additional societal burden in lost productivity and quality of life not even taken into account …”

“…26 Behavioral profiling includes assessing someone's capacities, opportunities and motivation for preventative behavior, 32 social and financial support, 23 treatment adherence, 9 and physical activity patterns. 26 While clinicians may already be aware of these factors in their patients, argue that the current lack of knowledge and current efforts employed are even more expensive, as each ulcer not prevented costs on average about €10,000 per ulcer episode in medical costs alone, 3,33,34 with the additional societal burden in lost productivity and quality of life not even taken into account. 35…”

“…2 Diabetic foot disease poses a huge cost burden to health care systems. 3 The burden of diabetic foot disease is ranked in the top-10 of all medical conditions, 4 and up to 34% of all people with diabetes are estimated to have a foot ulcer somewhere during their life. 5 Prevention of foot ulcers and amputations is crucial to decrease this enormous patient, healthcare, and societal burden.…”

Using health economics to count the cost of diabetes

“…Using patient‐level data, Kerr et al . estimated that 2% of people with diabetes experience foot ulcers annually, with diabetes‐related foot disease consuming £837 m to £962 m (almost 1% of the health services budget). Most of the costs are attributable to ulcer care, suggesting that cost savings of £250 m annually would be seen if the prevalence of ulcers could be reduced by 33%.…”

“…They are used primarily to identify major cost drivers, for advocacy, raising awareness and highlighting the importance of directing more research towards a particular area. Two of the studies in this issue are cost-of-illness studies investigating the cost of diabetic foot ulcers and amputations to the National Health Service in the England [1] and the costs of treating diabetic ketoacidosis in an adolescent population in the UK [2]. Using patient-level data, Kerr et al [1] estimated that 2% of people with diabetes experience foot ulcers annually, with diabetes-related foot disease consuming £837 m to £962 m (almost 1% of the health services budget).…”