Journal of diabetes and its complications · 2026
Exploring the societal cost of major lower limb amputations in patients with type 2 diabetes - A nation-wide and matched register study using difference in difference analysis.
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Fredslund Eskild Klausen, Londero Louise Skovgaard, Buhl Christian Selmer
Аннотация
AIM: This study estimates the societal costs associated with major lower limb amputations related to type 2 diabetes mellitus (T2DM) in Denmark.
METHODS: A nationwide, register-based matched cohort study was conducted with a case-control design with propensity score matching and a difference-in-difference approach to control for underlying time trends. Patients with T2DM that had an amputation in 2016 and 2017 were identified and propensity score matched 1:1 with controls.
RESULTS: A total of 698 patients with T2DM that had an amputation was identified and successfully matched 1:1 to controls. The study found that mortality was nearly 30% within the first quarter following amputation, increasing to approximately 70% over four years. The additional quarterly healthcare cost due to amputation was estimated at €2190 (p = 0.000), accompanied by a productivity loss of €1916 per quarter (p = 0.000). Over seven years, total health and home care costs reached €85,456, with an additional productivity loss of €53,648. These findings suggest that healthcare and home care costs alone account for only around 60% of care expenses, highlighting the broader economic and societal impact.
CONCLUSIONS: Major lower limb amputations related to T2DM impose significant economic and social costs, including healthcare expenditures and reduced productivity. This study underscores the importance of considering the full range of societal costs when developing preventive strategies for diabetic foot complications. A more comprehensive approach to prevention could lessen the financial burden on healthcare systems and society.
METHODS: A nationwide, register-based matched cohort study was conducted with a case-control design with propensity score matching and a difference-in-difference approach to control for underlying time trends. Patients with T2DM that had an amputation in 2016 and 2017 were identified and propensity score matched 1:1 with controls.
RESULTS: A total of 698 patients with T2DM that had an amputation was identified and successfully matched 1:1 to controls. The study found that mortality was nearly 30% within the first quarter following amputation, increasing to approximately 70% over four years. The additional quarterly healthcare cost due to amputation was estimated at €2190 (p = 0.000), accompanied by a productivity loss of €1916 per quarter (p = 0.000). Over seven years, total health and home care costs reached €85,456, with an additional productivity loss of €53,648. These findings suggest that healthcare and home care costs alone account for only around 60% of care expenses, highlighting the broader economic and societal impact.
CONCLUSIONS: Major lower limb amputations related to T2DM impose significant economic and social costs, including healthcare expenditures and reduced productivity. This study underscores the importance of considering the full range of societal costs when developing preventive strategies for diabetic foot complications. A more comprehensive approach to prevention could lessen the financial burden on healthcare systems and society.