Muzammil H Syed1,2, Konrad Salata2,3, Mohamad A Hussain2,3, Abdelrahman Zamzam2, Charles de Mestral2,3,4, Mark Wheatcroft2,3, John Harlock5,6, Deana Awartani7, Badr Aljabri2,7, Amol Verma8, Fahad Razak8, Subodh Verma2,9, Mohammed Al-Omran2,3,4,7. 1. Faculty of Science, McMaster University, Hamilton, Canada. 2. Division of Vascular Surgery, St. Michael's Hospital, Toronto, Canada. 3. Department of Surgery, University of Toronto, Toronto, Canada. 4. Diabetes Action Canada, Toronto, Canada. 5. Department of Surgery, Hamilton General Hospital, Hamilton, Canada. 6. Division of Vascular Surgery, Hamilton General Hospital, Hamilton, Canada. 7. Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia. 8. Division of General Internal Medicine, St. Michael's Hospital, Toronto, Canada. 9. Division of Cardiac Surgery, St. Michael's Hospital, Toronto, Canada.
Abstract
OBJECTIVE: Diabetic foot ulcer, which often leads to lower limb amputation, is a devastating complication of diabetes that is a major burden on patients and the healthcare system. The main objective of this study is to determine the economic burden of diabetic foot ulcer-related care. METHODS: We conducted a multicenter study of all diabetic foot ulcer patients admitted to general internal medicine wards at seven hospitals in the Greater Toronto Area, Canada from 2010 to 2015, using the GEMINI database. We compared the mean costs of care per patient for diabetic foot ulcer-related admissions, admissions for other diabetes-related complications, and admissions for the top five most costly general internal medicine conditions, using the Ontario Case Costing Initiative. Regression models were used to determine adjusted estimates of cost per patient. Propensity-score matched analyses were performed as sensitivity analyses. RESULTS: Our study cohort comprised of 557 diabetic foot ulcer patients; 2939 non-diabetic foot ulcer diabetes patients; and 23,656 patients with the top 5 most costly general internal medicine conditions. Diabetic foot ulcer admissions incurred the highest mean cost per patient ($22,754) when compared to admissions with non-diabetic foot ulcer diabetes ($8,350) and the top five most costly conditions ($10,169). Using adjusted linear regression, diabetic foot ulcer admissions demonstrated a 49.6% greater mean cost of care than non-diabetic foot ulcer-related diabetes admissions (95% CI 1.14-1.58), and a 25.6% greater mean cost than the top five most costly conditions (95% CI 1.17-1.34). Propensity-scored matched analyses confirmed these results. CONCLUSION: Diabetic foot ulcer patients incur significantly higher costs of care when compared to admissions with non-diabetic foot ulcer-related diabetes patients, and the top five most costly general internal medicine conditions.
OBJECTIVE:Diabetic foot ulcer, which often leads to lower limb amputation, is a devastating complication of diabetes that is a major burden on patients and the healthcare system. The main objective of this study is to determine the economic burden of diabetic foot ulcer-related care. METHODS: We conducted a multicenter study of all diabetic foot ulcerpatients admitted to general internal medicine wards at seven hospitals in the Greater Toronto Area, Canada from 2010 to 2015, using the GEMINI database. We compared the mean costs of care per patient for diabetic foot ulcer-related admissions, admissions for other diabetes-related complications, and admissions for the top five most costly general internal medicine conditions, using the Ontario Case Costing Initiative. Regression models were used to determine adjusted estimates of cost per patient. Propensity-score matched analyses were performed as sensitivity analyses. RESULTS: Our study cohort comprised of 557 diabetic foot ulcerpatients; 2939 non-diabetic foot ulcer diabetespatients; and 23,656 patients with the top 5 most costly general internal medicine conditions. Diabetic foot ulcer admissions incurred the highest mean cost per patient ($22,754) when compared to admissions with non-diabetic foot ulcer diabetes ($8,350) and the top five most costly conditions ($10,169). Using adjusted linear regression, diabetic foot ulcer admissions demonstrated a 49.6% greater mean cost of care than non-diabetic foot ulcer-related diabetes admissions (95% CI 1.14-1.58), and a 25.6% greater mean cost than the top five most costly conditions (95% CI 1.17-1.34). Propensity-scored matched analyses confirmed these results. CONCLUSION:Diabetic foot ulcerpatients incur significantly higher costs of care when compared to admissions with non-diabetic foot ulcer-related diabetespatients, and the top five most costly general internal medicine conditions.