How Much Does a Diabetic Foot Cost? The Economic Impact From a Multidisciplinary Approach to Care

Diabetes Mellitus (DM) is a worldwide public health concern with an estimated 537 million living with the disease. The direct cost of DM has been reported as 12. 2 to 16. 9 billion (Canadian dollars) per year over the last decade. These costs account for approximately four-and-a-half percent of the national healthcare budget. Diabetic foot ulcer (DFU) is a costly complication of DM. Three percent of patients with DM will develop a DFU per year, with a lifetime risk of 15% to 25%. The national prevalence of DFU is nearly two-and-a-half times greater than the prevalence worldwide. The prevalence of DM in the study province is amongst the highest in Canada at 15% to 19% and expected to increase 18% over the next decade. There are no studies that provide a comprehensive cost analysis of DFU in Canada. The objective of this study is to determine the total direct costs of DFU within a regional health authority of this province. It is hypothesized that the total direct cost of DFU in this province is underestimated. Patients with a provincial health care number seen at a regional health facility between 2017 and 2019 for DFU were selected for a retrospective chart review-based study. The province's institute for health information dataset captured all inpatient admissions, each of which had a unique International Classification of Diseases (ICD) code. To estimate the frequency of admissions, emergency room (ER) visits, and surgeries related to DFU, all ICD codes for the most responsible diagnosis were reviewed. Data on clinic visits, blood work, diagnostic imaging, and interventional radiology was collected from the electronic medical record and cost estimates were provided from the finances department of the health authority. Physician billing fees were estimated from the medical payment schedule and the total direct costs were calculated. Of 1265 charts reviewed, 200 were randomly selected for data analysis. Data was extrapolated to represent total costs to the healthcare system from 2017 to 2019, inclusive. The majority (75%) of patients were assessed in the ER for their DFU at least once with 50% presenting five or more times. The average length of stay was 19. 33 (34. 04) days. Average cost of admission was 32, 100 per person over the study period. The annual cost of ER, admissions, and surgical interventions was 1, 758, 567, 13, 535, 458, and 1, 178, 628 respectively. The cumulative regional cost of DFU was more than 54 million during the study time frame, with a per person cost of over 42 thousand. The cost of DFU in this province is grossly underestimated. Direct, per incident cost to the healthcare system is double of what has been estimated by previous national level analysis. Acute management of DFU in this region utilized approximately 27% of the provincial budget dedicated to diabetic care, as predicted by Diabetes Canada. National and Provincial budgets need to plan for the likelihood that DFU is currently underfinanced and will continue to grow as a problem in the future.