The Economic impact of Lower Extremity Amputations in Diabetics. A retrospective study from A Tertiary Care Hospital of Faisalabad, Pakistan

Abstract

Background: Among the various complications of diabetes, lower-extremity amputation due to diabetic foot is a common problem. In Pakistan, 6-7% of patients with diabetes suffer from diabetic foot ulceration.
 Objectives: Our primary objective was to explore the frequency of diabetic foot amputations, and the secondary objective was to calculate the economic burden of these preventable surgeries on the health budget of the provincial government.
 Materials & Methods: It was a retrospective cross-sectional observational study conducted after obtaining approval from the Ethical Review Committee of Allied hospital, Faisalabad Medical University. The data of diabetic foot patients who underwent amputations between July 2017 and December 2017 were retrieved from three Surgical Units (I, II & III), using a purposive sampling technique. All amputations carried out for reasons other than diabetic foot were excluded. The direct medical cost of one diabetic foot amputation was calculated via a local survey of the various private hospitals of Faisalabad. The indirect costs in terms of loss of productivity and disability costs, transport costs, rehabilitation costs were not included in this study. The data were evaluated by using SPSS Version 23.
 Results: A total of 85 patients were included in our study. The male to female ratio was 2.7 to 1. The mean direct treatment cost for minor amputation was PKR 46926.00 ± 11730.90 ($382.35 ± 95.58), and the mean direct treatment cost for major amputation was PKR 53720.00 ± 12401.24 ($437.71 ± 101.40). Out of 85 amputations, 63 (74%) were major amputations, and the remaining 22 (26%) were minor amputations. The total cost for 63 major amputations was PKR 3,384,360 ($27568.91) and for 22 minor amputation was PKR 1,032,372 ($8409.67). The net cost came out to be PKR 4,416,732 ($35978.59) for all the 85 cases being reported in a tertiary care hospital of Faisalabad for six months.
 Conclusion: Diabetic foot, a preventable complication of long-term diabetes mellitus, has an economic burden on the hospital budget, which, if adequately addressed via primary prevention programme, can yield not just economical but medical benefits as well.

Development and content validation of a financial and functional outcomes tool for diabetes-related foot disease in patients undergoing major lower limb amputation: a prospective observational study from Pakistan

“…A study conducted in the USA found that the mean cost associated with major amputations in patients with diabetes amounted to US$73 222 7. In a retrospective study conducted in Faisalabad, the mean direct cost of MLLA was PKR 53 720.00±12 401.24 (US$437.71±101.40) 8. Although there have been studies on the direct medical and non-medical expenses associated with MLLA, the indirect costs postdischarge has not been evaluated.…”

“… 7 In a retrospective study conducted in Faisalabad, the mean direct cost of MLLA was PKR 53 720.00±12 401.24 (US$437.71±101.40). 8 Although there have been studies on the direct medical and non-medical expenses associated with MLLA, the indirect costs postdischarge has not been evaluated. These indirect expenses encompass various factors such as purchasing prosthetics or crutches, loss of employment, selling an asset to compensate for the financial loss and several other associated costs.…”

Life before limb: What about life after limb loss? A perspective from a low middle class income country: A Surgical Perspective

“…A more recent retrospective review conducted in 2019, of 63 patients from Faisalabad concluded that the operative cost alone of major amputations in a period of six months was USD 27,568 in a government run hospital that amounts to USD 437 per patient, which is a significant number. 8 Again this did not take into account the postoperative period, highlighting the lack of assessment of the financial impact for diabetic foot syndrome in Pakistan and its functional and financial outcomes. We believe that the cost estimates done for these patients underestimates the true financial impact which the patient has to bear in real life.…”