The burden of costs on health services by patients with neuro-ischaemic ulcers in Singapore

Int Wound J. 2023 Mar;20(3):669-677. doi: 10.1111/iwj.13908. Epub 2022 Aug 10.


The economic burden of neuro-ischaemic ulcers (NIU) is expected to increase because of rising prevalence of comorbidities in an aging population. We aim to estimate healthcare resources consumed by NIU patients, and to quantify the extent to which factors explain variation in cost-related outcomes. We analysed retrospective patient-level cohort data for NIU patients from a tertiary hospital registry in Singapore, from 2013 to 2017, using generalised linear regression models. The outcome variables were the length of stay per admission; inpatient and outpatient bill per admission; and, if they had an Emergency Department visit. Cost outcomes were reported in Singapore dollars (S$). A total of 1682 patients were included, and the mean age was 69.9 years (±13.0). An average patient incurred a length of stay of 38.7 days, 7.9 inpatient dressing sessions, an inpatient bill of S$33 096, 11.3 outpatient dressing sessions, and an outpatient bill of S$8780. Inpatient services per patient cost 73.5% higher than outpatient services. NIU patients with multiple (>3) comorbid conditions, peripheral artery disease, or chronic kidney disease incurred longer hospitalisation and higher inpatient bill. Patients with diabetes mellitus and coronary artery disease had higher odds of incurring an ED visit. Patients with coronary artery disease, hyperlipidaemia, kidney complications, or obesity incurred higher outpatient bills. NIU treatment imposes a significant economic burden, especially with inpatient services.

Keywords: chronic wound; economic burden; neuro-ischemic ulcer.

MeSH terms

  • Aged
  • Coronary Artery Disease*
  • Health Care Costs
  • Hospitalization
  • Humans
  • Peripheral Arterial Disease*
  • Retrospective Studies
  • Singapore / epidemiology
  • Ulcer