Losing a foot versus losing a dollar; a systematic review of cost studies in diabetic foot complications

Expert Rev Pharmacoecon Outcomes Res. 2017 Apr;17(2):165-180. doi: 10.1080/14737167.2017.1305891. Epub 2017 Mar 17.


Diabetes mellitus is a chronic disease with high prevalence worldwide and a range of serious related complications. Amongst them, diabetic foot is one of the most disabling, posing a substantial health and economic burden on patients and healthcare systems. Areas covered: According to projections, the expected lower limb morbidity is about to increase - in this light the present review aimed at identifying cost-of-illness studies on the management and treatment of conditions related to the diabetic foot, in an aim to provide a body of evidence for an increasing health care burden. Expert commentary: Recent literature review surfaced a plethora of cost studies. Despite heterogeneity of foot complications and geographic variations, the search methodology revealed substantial costs and further healthcare burden for people with diabetes. Amputations due to suboptimally treated foot infections contribute to the already high rates of hospitalizations and readmissions. The cost of amputation ranges between $35,000 and $45,000 in the developed countries, however it largely depends on the amputation type. Moreover, the findings suggest that the cost of amputation in the US is generally higher compared to the cost in European countries. The cost of amputation in developing countries is substantially lower, as it approximates $5,000.

Keywords: Cost; diabetes; diabetic foot; expenditure; health care expenditure.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Amputation / economics
  • Cost of Illness*
  • Diabetes Mellitus / epidemiology
  • Diabetic Foot / economics*
  • Diabetic Foot / therapy
  • Health Care Costs / statistics & numerical data*
  • Hospitalization / economics
  • Hospitalization / statistics & numerical data
  • Humans
  • Patient Readmission / statistics & numerical data
  • Prevalence