Economics of the diabetic foot:a cost-of-illness study in Saudi Arabia

Background: Diabetes mellitus (DM) is a chronic disease today’s societies encounter. Diabetes symptomatology implies a definitive hormonal background involving insulin production, or its tissue uptake (types 1 and 2 diabetes, respectively); however its exact etiology is still unknown. Diabetes is a disease of complications, e.g., angiopathy, neuropathy; particularly diabetic foot disorders (DFDs) which can be devastating. Amputation, especially following ulceration is a catastrophic endpoint of DFDs. Saudi Arabia suffers a terrifying DM situation (>20% adults), aggravated by high obesity rates and modernized way of living. Above 25% Saudi diabetics develop DFDs, >25% of whom end up with amputation. “Cost of illness” (COI) can be used to estimate the economic burden of DFDs. This work focuses on COI in DFDs in Saudi; identifying risks affecting this cost. Methodology: Records of adult diabetics with DFDs enrolled with a major insurance agency in Jeddah, KSA were reviewed. Studied data included demographics, intervention options, and reimbursement as a COI measurement during fiscal year (FY) 2015. A quota sample of 60 diabetics was recruited; their risk factors for developed DFDs and COI analyzed. Results: The median age of participants was 58y (IQR 3y). Male: female 2.53:1; and Saudi: non-Saudi 4:1. Most subjects (43.3%) needed debridement, 35% minor amputation, 15% major amputation, and 6.7% conservative treatment for their DFDs episodes. Age≥55 significantly required more intensive intervention compared to younger age (minor amputation 35% vs. 0%, major amputation 15% vs. 0%, respectively; Fisher’s exact 8.567, p=0.011). Age significantly impacted COI [r(df=58) =0.333, p=0.009]. Saudis significantly experienced amputation more frequently than non-Saudis (33.3% vs. 1.7% major amputation, 15.0% vs. 0.0% minor amputation, respectively; Fisher’s exact 11.98, p=0.004). They also bear higher COI [t(df 55.6= 4.7, p<0.0001). Mean COI significantly varied by intervention option [F (df 3, 56) =101.3, p<0.0001]. Age could predict change in COI (Exp B = 1.84, 95% 1.2 - 2.74. Although COI varied by type of intervention, the latter could not predict such change in COI. Conclusion: Age is risk for a worsened DFDs prognosis and higher costs. Saudis are at risk of more costly DFs. The change in COI could be predicted by studied risks. Findings from this work can be used in developing an integrated DFDs database, planning to alleviate DFDs burden and improve the health related quality of life Saudi diabetic patients.