Costs of diabetic foot disease – a worldwide overview

Diabetic foot disease is a costly complication of diabetes, something that has been known for years. Various studies from all over the world have outlined these costs, each time pointing at costly care episodes for uninfected ulcers, with costs spiraling out of control when hospitalization is needed. For the first time, all these studies have been summarized in an extensive systematic review. Their conclusion is not surprising, seeing many of the included studies are well-known. But the staggering number of 56 studies all showing the same high costs for diabetic foot disease make for a strong argument that these costs warrant action.

In this new research article, studies were included from all over the world. All studies found lower costs for non-complicated ulcers, and significant increases when these ulcers became infected or when patients needed prolonged inpatient treatment or amputation. Seeing all these studies together, the importance of prevention and early multi-disciplinary intervention cannot be louder. If we are to control costs, patients need to be seen by experienced foot clinics, before it’s too late and hospitalization or amputation unavoidable.

The exact costs varied greatly between studies, also depending on how they were presented (e.g. as monthly or yearly costs, as costs per episode, par patient or per healthcare system, in whether or not indirect costs were also included, etc.). Roughly, prolonged hospitalization or amputation costs about 35,000 to 45,000 international dollars (a currency to compare different studies) in Australia, Europe or America, and around 5,000 dollars in developing countries. One remark that misses in the paper when reflecting on these different costs, is Peter Cavanagh’s statement in his interesting paper comparing costs in five countries: those 5,000 dollars may reflect 5.7 years of your annual income, with no government or health insurance to pay it for you.

For daily clinical practice this paper is a great addition underlining the need of investing in prevention and early treatment of foot ulcers by highly skilled interdisciplinary foot clinics. Such highly skilled care may be expensive, but diabetic foot ulcers ending in hospital or with an amputation is much more expensive in the long term. As professor Harding says “no numbers, is no problem, especially for government”. Well, this new systematic review is full of numbers, and they all show a very costly but preventable disease.