The Astronomical Cost of Diabetic Foot Ulcers

In the U.S. alone, 34.2 million people suffer from diabetes, according to 2018 data, and an additional 88 million live with prediabetes, which, if left untreated, could lead to type 2 diabetes within the next 5 years. Those with diabetes have a 4% risk of developing a diabetic foot ulcer (DFU) within a year and a 34% risk of developing a DFU within their lifetime. What’s more, there’s an 80% probability that patients’ DFUs will reoccur.

DFUs take a large toll on patients’ quality of life as they can lead to decreased mobility and ultimately, a lack of participation in regular activities. Studies have shown that DFUs can also have negative psychological and social effects on patients due to increased caregiver tension, lack of socialization, financial deficits, and decreased employment.

In addition to impact on patients, the cost of DFUs have an enormous burden on the U.S. healthcare system – anywhere between $9 and 13 billion annually. In fact, the overall cost of medical expenses for patients with DFUs are over 5.4 times higher than for diabetic patients without them.

Resulting expenditures not only include the diagnosis and treatment of a DFU, but also other necessities such as home healthcare, outpatient visits, and subsequent hospitalizations. When associated costs such as productivity losses and disability payments are also included, annual costs of diabetic foot ulcers total $6.171 billion and $20,570 per patient in one study of neuropathic DFUs.

Without proper care, DFUs can lead to an infection that spreads to the soft tissue or bone that requires amputation, which occurs in around 1 in 6 DFUs. DFUs have become the number one cause of nontraumatic amputations in the U.S., with the total cost coming to around $52,000 for Medicare services per year.

Given the cost of DFUs to both the healthcare system and patients individually, researchers are aiming to find a more cost-effective solution to the treatment and prevention of recurrence of DFUs.  Lower Extremity Amputation Prevention (LEAP), a program developed by the U.S. Health Resources and Services Administration in 1992, seeks to educate both patients and physicians on the importance of skin care, encourage patient caution and diligence to foot care, and emphasize the need for regular podiatric visits to dramatically reduce lower extremity amputations.

By following basic treatment guidelines, occurrence of DFUs in diabetic patients could potentially be cut in half. There have also been advancements in treatment options that could potentially reduce the burden of DFUs. For example, use of lower extremity multiple nerve (ND) surgery as a treatment option could reduce DFU cases by 21% within 3 years, resulting in a potential savings of $1 billion annually.

Finding better ways to treat DFUs will not only improve patient outcomes and quality of life but reduce cost burdens both on individuals and the U.S. healthcare system.

Read how and why diabetic amputations spiked during the pandemic.