Counting the cost of preventable diabetes-related lower limb amputations at a single district hospital in KwaZulu-Natal: what does this mean, what can be done?

Background: Healthcare policy decisions are driven by many factors, including cost, hence the need to show costs of diabetes mellitus-related lower limb amputations (DMLLA) to inform amendments to health care. Substantial decreases in amputation rates are associated with specialised podiatry foot clinics and ongoing foot education, as per national guidelines on the multidisciplinary team approach (MDTA) to diabetes health care. There are only two podiatry posts in KwaZulu-Natal (KZN) state health department (DoH). Objectives: Aims were to draft the medical costs for 660 DMLLA at Greys Hospital for the period 2013–2017; to extrapolate costs on annual DMLLA in KZN; to outline socio-economic costs for future investigation; to present evidence that podiatry in the MDTA can decrease numbers of DMLLA. Methods: A retrospective review on clinical data captured in real time and maintained by the Pietermaritzburg Metropolitan Trauma Service (PMTS) and Surgical Service (PMSS) was performed. Costs were analysed on data for 660 patients’ DMLLA at Greys Hospital between 2013 and 2017, and psychological and socio-economic costs via literature review. Results: Medical care at Greys Hospital for 660 DMLLA in the five years cost in excess of ZAR 213 million. Extrapolated to the 1 231 diabetic amputations (2014) equals an annual cost to KZN DoH in excess of ZAR 398 million. Personal, family loss and socio-economic costs are estimated in excess of ZAR five million per amputee, resulting in further cost of ZAR 6.155 billion per annum to KZN. Extrapolation across 11 provinces signifies a national cost of at least ZAR 68 billion. Conclusions: We present a gauge of the cost of DMLLA to KZN and national health. Substantial possible socio-economic losses compound these. The role of podiatrists within MDTA teams has an evidence base to prevent DMLLA.