The personal cost of diabetic foot disease in the developing world - a study from Pakistan

Aims The aim of the present study was to estimate the direct cost of treatment of diabetic foot ulcer at a tertiary care hospital in Karachi, Pakistan in order to assess the extent of the economic burden which it imposes. Methods Out of 383 patients seen at Foot clinic of Baqai Institute of Diabetology and Endocrinology (BIDE), records of 214 patients were analyzed while 169 patients left against medical advice (LAMA). The UT system was used to classify ulcer types. Information was retrieved on resource consumption (physician services, chiropody, investigations, medicines, hospital care and surgical procedures). Interventions were summed and multiplied by the unit price of each resource, using charges levied at BIDE in the year 2005, in order to calculate the total cost of treatment. Results 64% were male, with mean age 52.7 +/- 10.2 years. Mean duration of diabetes was 16.2 +/- 6.6 years. Majority (62.1%) were Grade 2 ulcer. The estimated direct cost of management increased from 2700 +/- 250 rupees (21 pound +/- 2) for a UT grade 1, stage B ulcer to 37 415 +/- 24 125 rupees (288 pound +/- 186) for UT grade 2, stage D and 49 058 +/- 30 144 rupees (378 pound +/- 232) for UT grade 3, stage D ulcers, respectively. The mean direct cost of major amputation (transtibial or transfemoral) was 46 182 +/- 30 742 (356 pound +/- 237) whilst the cost of a minor amputation was 50 494 +/- 30 488 rupees (389 pound +/- 235). Conclusions This retrospective study, despite having limitations, is important for a developing world country with limited data on health economics. Further larger scale prospective studies are needed to address this issue in more detail.