The Economic Burden of Inpatient Treatment of Foot Ulcers in People with Diabetes is Unacceptable
By Krista Lamb
The cost of treating foot ulcers in people with diabetes continues to be incredibly high. A new study from Diabetes Action Canada researchers Drs. Mohammed Al-Omran and Charles de Mestral, shows that the cost for treatment of diabetic foot ulcers in Toronto hospitals is more than double that of the top five most costly conditions.
Part of this, the team explains, is that care for someone with a diabetic foot ulcer is fragmented. “Unfortunately, there’s no coordinated multi-disciplinary care for this existing province-wide in Ontario,” explains Al-Omran. “As a result, you expect the cost to be high, plus the care of these patients will be compromised. This is the reason we conducted this study.”
The paper, “The economic burden of inpatient diabetic foot ulcers in Toronto, Canada,” was published in the journal, Vascular, and looked at the cost of treating diabetic foot ulcers at eight Toronto hospitals. The team compared people who were admitted with diabetic foot ulcer complications against those admitted with different diabetes complications. They found that the cost for treating foot ulcers related to diabetes was almost $23,000/patient. A stroke, by comparison, costs about $10,000/patient to treat. If a patient experiencing a foot ulcer needed an amputation, the cost skyrocketed to almost $49,000.
These costs, Al-Omran explains are driven by the length of hospital stay and the rate of readmission. These are issues, he says that are made worse because of fragmented care and the lack of a clear treatment pathway.
Al-Omran and other researchers from Diabetes Action Canada have now developed a pilot program that is investigating how by streamlining care and providing a clear plan for treatment, these costs can be lowered and the patient will receive better and more consistent care. The program is currently running at St. Michael’s Hospital in Toronto with more than 100 patients registered.
The pilot, which provides a complete end-to-end plan involving a team of vascular surgeons, chiropodists, internists and others, is already starting to see promising results. Al-Omran has seen the cost of care dip substantially for those who are enrolled in the study, as the consistent and specialized care reduces the time in hospital and improves the overall results for patients.
Al-Omran and his team are doing further studies looking at the costs of diabetic foot ulcers across Canada in the hopes that this will help encourage policy makers to implement changes that will provide better results for patients, as well as reduced costs. Al-Omran also wants to see more prevention programming.
Amputation has been found to be the most feared complication of diabetes—more so than death or blindness—and after more than 20 years of working in this field Al-Omran knows that preventive care can have an enormous impact on avoiding this outcome.
“We know that 85% of people with a diabetic foot ulcer can be prevented from having amputation with very simple screening and interventions, like special foot care and footwear, frequent visits to their primary care providers, and access to a multi-disciplinary team for high-risk diabetic foot ulcers,” he says. He hopes this research will help improve access to these preventive strategies and decrease the number of foot ulcers requiring intervention or amputation.