SOCIO ECONOMIC COST OF
IMMEDIATE COSTS RECURRING COSTS
Cost of immediate episode Cost of long term care
Loss of income
Diabetic foot problems, whether infections, diabetic foot ulcers , charcot feet , diabetic foot neuropathy , diabetic foot pain ,diabetic foot swelling etc impose a major economic burden on both patients and caregivers.
A team approach to these problems lessens their complication rate , reduces problems and reduces the long term burden on patients and families. If we remember that about 15 – 25 % of diabetic patients suffer from diabetic foot ulcers during their lifetime and that many of these patients especially in India are in the productive phases of their life, the socioeconomic burden can be understood especially in terms of limb loss of the breadwinner of the family.
A patient without a diabetic foot ulcer compared to a patient with one, has to spend less on medical care on a regular basis. Also as many patients in India come to a health care giver either when they develop an ulcer or when they have a limb threatening infection and are then diagnosed to be diabetic, the costs of treatment go up phenomenally compared to when they are diagnosed earlier and put into preventive diabetic footwear and diabetes related foot education is provided.
Apart from limb loss or loss of life of the breadwinner of the family leading to reduction in earning capacity of the family and pushing them further down the economic scale, the presence of even a non productive member with a diabetic foot ulcer or diabetic foot wound or bedsores, sharply pushes up the amounts spent on medical care for the family, apart from the fact that in some families it may be difficult to offer prolonged care to such patients simply because the costs of care are extremely high and especially in families which subsist on daily wages it may be just impossible to take such patients for medical care till it is too late.
Almost 40% admissions in diabetics are due to diabetic foot complications. The diabetic foot with gangrene is one of the leading causes of death in diabetics.
More than 60-70% of all non traumatic lower limb amputations occur in diabetics.
The costs of care for diabetic foot ulcers are likely to keep increasing as newer and newer therapies come up and also for insured patients, insurance companies are unlikely to reimburse the costs of all therapies used to treat chronic ulcerations, limb infections, gangrene etc. It is also important to remember that the rates of recurrence of foot ulcers are very high and can be greater than 50% after three years. So the cost should not only include the current episode but also the home care , subsequent ulcer episodes , loss of income due to quality of life change and the final outcome. In such a scenario the case for a multidisciplinary team which focuses on prevention , early recognition and multi modality treatment in the case of limb or life threatening infections, becomes stronger as it will have a short term as well as long term impact on reducing health care costs for the diabetic foot.
Whereas in India, a patient without a foot ulcer is likely to spend money only on medicines, insulins , three monthly check ups and routine investigations which may vary from about Rupees 5000 – 15000 per year, a patient with a diabetic foot ulcer may need to spend double the amount. However a patient who has a limb threatening or life threatening infection may spend in lakhs of rupees per episode along with the long term costs of reduced earning capacity and being a financial burden on the family. Apart from this in case of amputation, the chances of further amputation whether in the same or opposite foot increase dramatically.