The economic burden of inpatient diabetic foot ulcers in Toronto, Canada

Abstract

Objective Diabetic foot ulcer, which often leads to lower limb amputation, is a devastating complication of diabetes that is a major burden on patients and the healthcare system. The main objective of this study is to determine the economic burden of diabetic foot ulcer-related care. Methods We conducted a multicenter study of all diabetic foot ulcer patients admitted to general internal medicine wards at seven hospitals in the Greater Toronto Area, Canada from 2010 to 2015, using the GEMINI database. We compared the mean costs of care per patient for diabetic foot ulcer-related admissions, admissions for other diabetes-related complications, and admissions for the top five most costly general internal medicine conditions, using the Ontario Case Costing Initiative. Regression models were used to determine adjusted estimates of cost per patient. Propensity-score matched analyses were performed as sensitivity analyses. Results Our study cohort comprised of 557 diabetic foot ulcer patients; 2939 non-diabetic foot ulcer diabetes patients; and 23,656 patients with the top 5 most costly general internal medicine conditions. Diabetic foot ulcer admissions incurred the highest mean cost per patient ($22,754) when compared to admissions with non-diabetic foot ulcer diabetes ($8,350) and the top five most costly conditions ($10,169). Using adjusted linear regression, diabetic foot ulcer admissions demonstrated a 49.6% greater mean cost of care than non-diabetic foot ulcer-related diabetes admissions (95% CI 1.14–1.58), and a 25.6% greater mean cost than the top five most costly conditions (95% CI 1.17–1.34). Propensity-scored matched analyses confirmed these results. Conclusion Diabetic foot ulcer patients incur significantly higher costs of care when compared to admissions with non-diabetic foot ulcer-related diabetes patients, and the top five most costly general internal medicine conditions.

Worldwide Research Trends on Diabetic Foot Ulcers (2004–2020): Suggestions for Researchers

“…More than 85% of foot amputations are caused by DFU [ 2 ]. Syed et al pointed out that the average nursing cost of hospitalised patients with DFU is 49.6% higher than that of inpatients with non-DFU-related diabetes [ 3 ]. DFU brings serious psychological, physical, and economic burdens to patients, so the International Diabetes Foundation is paying close attention to this disorder [ 4 ].…”

Association of diabetes with frequency and cost of hospital admissions: a retrospective cohort study

“…26 In Canada and the US, decades of improvements in rates of nontraumatic lower-extremity amputations in patients with diabetes have recently reversed, especially among younger adults. [27][28][29] A 2017 international meta-analysis comparing the prevalence of diabetic foot ulcers across 33 countries has found Canada (14.8%) to have the second highest rate, after Belgium (16.6%). 30 Foot care is one of the most neglected components of standard diabetes care practices, with only 51% of Canadian patients with diabetes having their feet checked as recommended.…”

Proportion and severity of periodontitis and correlation of periodontal inflamed surface area with glycemic status in patients with type 2 diabetic neuropathy with and without diabetic foot

“…Diabetic neuropathy is also associated with an increased risk of diabetic foot ulceration 16 which is one of the most serious, neglected, and costly complications of diabetes. In a large multicenter study, it was observed that treatment costs were significantly higher for diabetic foot ulcer in patients when compared with patients with other diabetes‐related complications 17 . The etiopathogenesis of diabetic foot ulcer is multifactorial but the predominant factor is diabetic neuropathy—both sensory‐motor and autonomic neuropathy 18 .…”

“…In a large multicenter study, it was observed that treatment costs were significantly higher for diabetic foot ulcer in patients when compared with patients with other diabetes-related complications. 17 The etiopathogenesis of diabetic foot ulcer is multifactorial but the predominant factor is diabetic neuropathy-both sensory-motor and autonomic neuropathy. 18 Diabetic polyneuropathy mainly affects nerve growth factor (NGF)-dependent nerve structures and a shortage of NGF causes complex dysfunction of cellular and extracellular wound healing.…”