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

TLDR

Diabetic foot ulceration is a growing global problem that drives substantial NHS expenditure, largely due to prolonged and severe ulcers. The study aims to estimate the NHS healthcare costs of diabetic foot disease in England. The authors used national and local patient‑level datasets and clinical evidence to estimate annual costs of foot ulceration and amputation in England for 2014–2015. Diabetic foot care cost in England 2014–2015 was estimated at £837–962 million (0.8–0.9 % of the NHS budget), with over 90 % of spending on ulceration and 60 % in community/outpatient settings; ulceration increased inpatient stays by ~8 days, and reducing ulcer prevalence by one‑third could save over £250 million.

Abstract

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.