Cost of diabetic foot disease to the NHS in England

NewsBot · Jul 5, 2014

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Cost of diabetic foot disease to the National Health Service in England
M. Kerr, G. Rayman andW. J. Jeffcoate
Diabetic Medicine; Accepted Article

Aim
To estimate the annual cost of diabetic foot care in a universal healthcare system.

Methods
National datasets and economic modelling were used to estimate the cost of diabetic foot disease to the National Health Service in England in 2010–2011. The cost of hospital admissions specific to foot disease or amputation was estimated from Hospital Episode Statistics and national tariffs. Multivariate regression analysis was used to estimate the impact of foot disease on length of stay in other admissions. Costs in other areas were estimated from published studies and data from individual hospitals.

Results
The cost of diabetic foot care in 2010–2011 is estimated at £580m, almost 0.6% of National Health Service expenditure in England. We estimate that more than half this sum (£307m) was spent on care for ulceration in primary and community settings. A total of 8.8% of hospital admissions with recorded diabetes included ulcer care or amputation. Regression analysis suggests that foot disease was associated with a 2.51-fold (95% CI 2.43–2.59) increase in length of stay.The cost of inpatient ulcer care is estimated at £219 m, and that of amputation care at £55 m.

Conclusions
The cost of diabetic foot disease is substantial. Ignorance of the cost of current care may hinder commissioning of effective services for prevention and management in both community and secondary care.
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Admin2 · Jul 5, 2014

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NewsBot · Nov 11, 2017

Diabetes-related amputations create considerable public health burden in the UK
Heather Graz et al
Article in Press; Diabetes Research and Clinical Practice

Aims
The main aim of this study was to assess the cost of diabetic amputation (both direct and indirect) to the National Health Service from the point of amputation onwards.

Methods
This systematic review involved searches of published literature between January 2007 and March 2017 mainly using the bibliographic databases, the Cochrane Library, EMBASE via Ovid®, MEDLINE via Ovid®, as well as grey literature, both in print and in electronic formats published through non-commercial publications, which reported the cost of amputation due to diabetic foot ulcers

Results
The studies included in this review varied considerably in estimating the cost including cost elements and how those costs were categorised. The cost estimates for inpatient care associated with amputation involving admissions or procedures on amputation stumps in people with diabetes was £43.8 million. The annual expenditure for post-amputation care involving prosthetic care, physiotherapy, transport and wheelchair use was £20.8 million.

Conclusions
There is a considerable public health and economic burden caused by diabetes-related amputations in England. More focussed research is needed with improved methods of estimating costs that would account for direct and indirect costs associated with diabetic amputation.
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NewsBot · Jul 6, 2019

The cost of diabetic foot ulcers and amputations to the
National Health Service in England
M. Kerr et al
Diabet. Med. 00: 1–8 (2019)

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.
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NewsBot · Jan 9, 2024

Development of a resource-use measure to capture costs of diabetic foot ulcers to the United Kingdom National Health Service, patients and society
Katherine Cullen et al
J Res Nurs. 2023 Dec;28(8):565-578

Background: Diabetic foot ulcers (DFUs) add a significant burden to the lives of people with diabetes in the United Kingdom. They can have a considerable impact on a patient's daily life, with treatment requiring frequent changes of dressings and clinic attendances. Nurses and other allied health professionals (AHPs) within the community provide most wound care representing the primary cost driver.

Aims: To collaboratively explore key resource use related to the management of DFUs to develop, and pilot, a participant-reported measure to inform economic evaluations.

Methods: A literature search and semi-structured interviews determined health and non-health resource use in management of DFUs. A consensus view of the selected items was established in a modified Delphi study and further tested for acceptability and validity in a pilot study.

Results: Primary care consultations with a podiatrist or orthotist, district nurse visits, out-of-hours and emergency care, scans and investigations, and consumables provided in clinics were rated as the most important resource use items.

Conclusions: This work has informed the development of a measure that captures resource use considered important by the people most affected by DFUs; patients, family members and carers, and the healthcare professionals key to DFU management.
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