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Diabetes-related amputations create considerable public health burden in the UK

Published:November 10, 2017DOI:https://doi.org/10.1016/j.diabres.2017.10.030

      Highlights

      • Studies varied considerably in estimating costs involved in diabetic amputation.
      • Inpatient care costs associated with diabetic amputation were £43.8 million.
      • Post-amputation care annual expenditure was £20.8 million.
      • Diabetes-related amputations create considerable public health and economic burden.

      Abstract

      Aims

      The main aim of this study was to assess the cost of diabetic amputation (both direct and indirect) to the National Health Service from the point of amputation onwards.

      Methods

      This systematic review involved searches of published literature between January 2007 and March 2017 mainly using the bibliographic databases, the Cochrane Library, EMBASE via Ovid®, MEDLINE via Ovid®, as well as grey literature, both in print and in electronic formats published through non-commercial publications, which reported the cost of amputation due to diabetic foot ulcers.

      Results

      The studies included in this review varied considerably in estimating the cost including cost elements and how those costs were categorised. The cost estimates for inpatient care associated with amputation involving admissions or procedures on amputation stumps in people with diabetes was £43.8 million. The annual expenditure for post-amputation care involving prosthetic care, physiotherapy, transport and wheelchair use was £20.8 million.

      Conclusions

      There is a considerable public health and economic burden caused by diabetes-related amputations in England. More focussed research is needed with improved methods of estimating costs that would account for direct and indirect costs associated with diabetic amputation.

      Keywords

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      References

        • Holman N.
        • Young R.J.
        • Jeffcoate W.J.
        Variation in the recorded incidence of amputation of the lower limb in England.
        Diabetologia. 2012; 55: 1919-1925https://doi.org/10.1007/s00125-012-2468-6
      1. Diabetes UK. State of the Nation 2012: England 2012:1–35.

      2. Diabetes Prevalence Model 2016.

      3. Costing report Implementing the NICE guideline on diabetic foot problems (NG19) Putting NICE guidance into practice 2015.

        • Moulik P.K.
        • Mtonga R.
        • Gill G.V.
        Amputation and mortality in new-onset diabetic foot ulcers stratified by etiology.
        Diabetes Care. 2003; 26
      4. Diabetic foot problems: prevention and management 2015. https://www.nice.org.uk/guidance/ng19/chapter/About-this-guideline.

        • Wrobel J.S.
        • Mayfield J.A.
        • Reiber G.E.
        Geographic variation of lower-extremity major amputation in individuals with and without diabetes in the medicare population.
        Diabetes Care. 2001; 24
        • Vamos E.P.
        • Bottle A.
        • Majeed A.
        • Millett C.
        • Rayman A.
        • Hall E.
        • et al.
        Trends in lower extremity amputations in people with and without diabetes in England, 1996–2005.
        Diabetes Res Clin Pract. 2010; 87: 275-282https://doi.org/10.1016/j.diabres.2009.11.016
      5. Search filters n.d. http://www.sign.ac.uk/search-filters.html (accessed 5 July 2017).

      6. Kerr M. Foot care for people with diabetes: the economic case for change. NHS Diabetes Kidney Care 2012.

        • Kerr M.
        • Rayman G.
        • Jeffcoate W.J.
        Cost of diabetic foot disease to the National Health Service in England.
        Diabet Med. 2014; 31: 1498-1504
      7. Kerr M. DIABETIC FOOT CARE IN ENGLAND: AN ECONOMIC STUDY 2017.

        • Alva M.L.
        • Gray A.
        • Mihaylova B.
        • Leal J.
        • Holman R.R.
        • A M.L.
        • et al.
        The impact of diabetes-related complications on healthcare costs: new results from the UKPDS (UKPDS 84).
        Diabet Med. 2015; 32: 459-466
        • Hex N.
        • Bartlett C.
        • Wright D.
        • Taylor M.
        • Varley D.
        Estimating the current and future costs of Type 1 and Type 2 diabetes in the UK, including direct health costs and indirect societal and productivity costs.
        Diabet Med. 2012; 29: 855-862https://doi.org/10.1111/j.1464-5491.2012.03698.x
      8. Public Expenditure HM Treasury contacts 2016.

      9. Curtis L. Unit Costs of Health and Social Care 2011. Pers Soc Serv Res Unit, 2011 2011. http://www.pssru.ac.uk/project-pages/unit-costs/2011/ (accessed 23 May 2017).

      10. NHS reference costs 2014 to 2015. Dep Heal n.d. https://www.gov.uk/government/publications/nhs-reference-costs-2014-to-2015 (accessed 23 May 2017).

        • Whitston M.
        • Chung S.
        • Henderson J.
        • Young B.
        What can be learned about the impact of diabetes on hospital admissions from routinely recorded data?.
        Diabet Med. 2012; 29: 1199-1205https://doi.org/10.1111/j.1464-5491.2011.03535.x
        • Ince P.
        • Game F.L.
        • Jeffcoate W.J.
        Rate of healing of neuropathic ulcers of the foot in diabetes and its relationship to ulcer duration and ulcer area.
        Diabetes Care. 2007; 30
        • Canavan R.J.
        • Unwin N.C.
        • Kelly W.F.
        • Connolly V.M.
        Diabetes- and nondiabetes-related lower extremity amputation incidence before and after the introduction of better organized diabetes foot care.
        Diabetes Care. 2008; 31
        • Vamos E.P.
        • Bottle A.
        • Edmonds M.E.
        • Valabhji J.
        • Majeed A.
        • Millett C.
        Changes in the incidence of lower extremity amputations in individuals with and without diabetes in england between 2004 and 2008.
        Diabetes Care. 2010; 33: 2592-2597https://doi.org/10.2337/dc10.0989
        • Krishnan S.
        • Fowler D.
        • Nash F.
        • Rayman G.
        • Baker N.
        Reduction in diabetic amputations over 11 years in a defined UK population.
        Diabetes Care. 2008; 31: 99-101https://doi.org/10.2337/dc07-1178
      11. National Audit Office. The management of adult diabetes services in the NHS. vol. 489. The Stationery Office; 2012.

      12. National Diabetes Inpatient Audit England and Wales, 2016. NHS Digit 2017. http://content.digital.nhs.uk/catalogue/PUB23539/nati-diab-inp-audi-16-rep.pdf (accessed 8 May 2017).

        • Blanes J.I.M.
        Representatives of Spanish Society of Surgeons (ACS), Representatives of Spanish Society of Angiology and Vascular Surgery (SEACV), Representatives of Spanish Society of Emergency Medicine (SEMES), Spanish Internal Medicine Society (SEMI), Representatives of Spanish Society of Critical Care Medicine and Coronary Units (SEMICYUC), et al. Consensus document on treatment of infections in diabetic foot.
        Rev Esp Quimioter. 2011; 24: 233-262
        • Peters E.J.
        • Lipsky B.A.
        • Aragón-Sánchez J.
        • Boyko E.J.
        • Diggle M.
        • Embil J.M.
        • et al.
        Interventions in the management of infection in the foot in diabetes: a systematic review.
        Diabetes Metab Res Rev. 2016; 32: 145-153https://doi.org/10.1002/dmrr.2706
      13. Selva Olid A, Solà I, Barajas-Nava LA, Gianneo OD, Bonfill Cosp X, Lipsky BA. Systemic antibiotics for treating diabetic foot infections. In: Selva Olid A, editor. Cochrane Database Syst. Rev., Chichester, UK: John Wiley & Sons, Ltd; 2015. doi:10.1002/14651858.CD009061.pub2.