Comparison of costs related to health services in two groups of patients with diabetic foot ulcer and patients without this complication: a matched cohort study.

Introduction: Diabetic foot ulcer (DFU) is a serious complication of diabetes that significantly increases healthcare expenditure worldwide. The aim of this study is to calculate the average costs for patients with and without DFU over a nine-month period.

Methods: This cost-of-illness study comprised 480 patients, including 160 cases (with DFU) and 320 controls (diabetes only), matched 1:2 by age (± 5 years) and sex. Direct and indirect medical costs were collected over a nine-month period using a questionnaire. We used the Mann-Whitney U test for continuous variables and the Pearson chi-square test for categorical variables. The GLM was also used to predict costs based on demographic and clinical factors. All statistical analyzes were performed using SPSS with a significance level of p < 0.05.

Results: The average total direct medical costs (inpatient and outpatient) were PPP$ 3,493.64 (SD: 2,714.66) for the DFU group and PPP$ 1,353.44 (SD: 110.85) for the diabetes-only group. Medication expenditures were the highest outpatient costs in the DFU group, with a mean of PPP$ 1,079.59 (SD: 247.13) (P < 0.001). Mean transportation costs in the DFU group were PPP$ 299.66 (SD: 240.49), compared with PPP$ 96.01 (SD: 7.83) in the control group. The mean indirect costs were PPP$ 2,256.31 (SD: 1,332.39) for the DFU group and PPP$ 100.78 (SD: 24.63) for the control group. Patients with more advanced ulcer stages (B = 9050.275, p < 0.05) and with middle education levels (B = 208.77, p < 0.05) had significantly higher costs. In contrast, retired individuals had significantly lower costs (B = -459.77, p < 0.05).

Conclusions: Patients with DFU incur substantially higher direct and indirect costs compared to those with diabetes alone. Medication and other service utilization-including blood glucose self-monitoring and consumables such as test strips, blood glucose meters, lancets, and syringes-are key contributors to outpatient expenses. The elevated indirect costs in DFU patients primarily reflect lost productivity. These higher overall costs are largely driven by the severity of the complication. Optimizing treatment strategies to prevent disease progression and avoid costly complications is essential for reducing the financial burden associated with DFU.