According to the CDC, diabetes is the most expensive chronic condition in the country with $1 out of every $4 in U.S. health care costs associated with diabetes care. That’s one-quarter of all health care spending in the nation. With over 34 million Americans with diabetes, annual costs reach $327 billion. But what about the cost of diabetic foot complications?
It’s clear that diabetes is an expensive condition, which makes it all the more critical to address. Not only does it cost people money, but it costs people their quality of life. Nothing could be more true than when we examine the economic burden of one of the most severe complications of diabetes: amputation. When people think of diabetic health care costs, they might not be including diabetic amputation in their calculations.
Diabetic foot complications are largely underestimated in terms of costs. This is partly because the population that suffers from these complications is actually quite small. Especially when compared to the larger population of all patients with diabetes mellitus, it can seem that this group is small enough to ignore.
That couldn’t be further from the truth. Despite the fact that this high-risk population with diabetes is a smaller piece of the overall pie, it’s this group that suffers from the highest overall health care spending and strain on their quality of life.
And it’s not necessarily a sliver of pie. People with diabetes have a 34% lifetime risk of developing a diabetic foot ulcer. And when we look at the costs of diabetic foot ulcers, it’s a significant jump in these high-risk patients.
Patients without diabetic foot ulcers cost around $17,000 each year. Patients with diabetic foot ulcers? $58,000. This demonstrates that there’s a clear link between health care costs and diabetic foot ulcers. A big, costly link.
If you can believe it, diabetic foot ulcers are actually more expensive than the five most costly forms of cancer. It totals over $100 billion. That’s astonishing to think about. Most of us are familiar with the costs of cancer, and we’re well-educated about the toll that cancer has on our nation. But diabetic foot ulcers are often swept under the rug in larger conversations about health care spending and costs, and this needs to change.
The Devastating Cycle of Diabetic Foot Ulcers
Every foot ulcer and amputation puts a patient at greater risk of having another one. Both complications tend to loop, and the toll keeps adding up. Recurrence statistics for diabetic amputations are bleak: 19% of people with diabetes will have another lower extremity amputation within a single year of their first, while nearly 37% will have another amputation within five years. Every surgery is significant and life-altering, compounding the negative impacts on patients and increasing health care costs.
The cost of diabetic foot complications is very severe: Lower extremity complications are present in over 200 DRG and ICD-10 codes. But who’s counting? It’s such a complex problem, and because the codes are often intertwined with other conditions, it’s not a metric that many health plans can easily run. (Fortunately, we can help with that.)
The vulnerable population at the highest risk for developing diabetic foot ulcers is also more likely to suffer from serious comorbidities that drive up their total cost of care: congestive health failure (CHF), renal failure, heart attack, and pulmonary edema, for example. Each of these comorbidities piles on, creating a significant strain on the health care system but, most importantly, weighing on every single patient.
This vulnerable group might only be 1% of the total population, but they account for 24% of all out-of-pocket spending. If you look at the top 5% of the population that spends the most, it leaps to nearly half. That means this small group is carrying a disproportionate amount of health care spending, and it’s a win-win for us to help them.
Not only would helping this high-risk group ease the burden on their quality of life, but it would also decrease overall out-of-pocket spending. Everything costs more for this group, and it’s part of why health care costs can be so overwhelming. It’s why people go bankrupt trying to afford health care. As each condition is linked to another, everything becomes more expensive and more difficult to treat. The sheer number of specialist visits and medications drive significant costs, and this burden leaves the patient overwhelmed and depressed.
Even more, because diabetic foot complications, in particular, are cyclical, this group is hit over and over again. Just when they start to get out from under it, it comes back again. This is hard on everyone: the patients, the health plans, and the doctors that treat them. No one wants this to happen to anyone, so how can we help?
Preventing Diabetic Foot Ulcers
The best way to address this is head-on. Let’s help prevent diabetic foot ulcers from occurring. That can be done with early intervention and remote temperature monitoring in the home, which can detect signs of inflammation before they become wounds that need treatment.
Additionally, health care plans can take a closer look at their metrics and calculate the true cost of diabetic foot complications, including ulcers and amputations.
The true cost of diabetic amputation also includes the burden on patient well-being and mental health. Did you know that most patients fear amputation more than death? When a lower limb is amputated, it takes independence away from that person. It increases fear and worry. It debilitates and discourages.
And we know that this population is also more like to face health inequity, as Black Americans and Hispanics are two to three times more likely to need diabetic amputation, and patients with diabetes living in our nation’s poorest communities are 39% more likely to have a high-level amputation. These are significant statistics, demonstrating the level of inequality that this population faces when it comes to diabetic amputations. Why are they more likely to suffer from diabetic foot complications? It’s a question that we must continue to understand in order to help our nation’s most vulnerable and to stop the devastating, costly cycle of diabetic foot complications.
Diabetic foot complications are severe. They cost everyone so, so much. That’s exactly why we must target these complications of diabetes — so that we can give everyone their freedom back. If we can detect signs of inflammation before they become diabetic foot ulcers, we can step in and prevent diabetic amputations.
The health care system, patients with diabetes, and providers that treat diabetes all need help with these devastating complications. By drawing attention to the problem, we can help more people live independently without the toll of surgeries as severe as diabetic amputations.
While the numbers may be daunting, it’s something that we can target. By addressing the population directly, we can make a significant contribution to alleviating the burden of health care costs associated with diabetes. To start, work with a Podimetrics representative to calculate your exact costs. The figure may be much higher than you expect. From there, you can learn more about simple, at-home solutions for diabetic foot complications that are backed by clinical evidence.
If you’re interested in reading more, check out our post on how to prevent diabetic amputation.