Hospitalization Costs for Diabetes Related Lower Extremity Amputation at a Referral Hospital in KwaZulu Natal, South Africa

Abstract

Background: Diabetes mellitus is a significant risk factor for lower extremity amputations (LEA), both alone and in combination with peripheral vascular disease and infection. Currently, in Africa, more than half of the cases do not meet the recommended blood glucose control levels to prevent complications suggesting that the risk of complications is high. Objective: The study aims to estimate hospitalization costs of diabetes-related lower extremities amputation for patients consulted at a referral hospital in 2015/16. Methods: The study was a retrospective analysis using a mixed costing approach and based on 2015/16 financial year data inflated to 2020 at a 32-bed vascular unit of a quaternary care health facility. Patient level data were extracted from the hospital information system for length of stay, medication provided, laboratory and radiological investigations, and other clinical services offered. Results: The total summative cost for managing all 34 patients amounted to $ 568 407 or a mean unit cost per patient of $ 16 718 based on 2015/16 prices, and when adjusted to 2020, prices amounted to $ 728 997 or $ 21 441 per patient. The mean unit cost per patient for foot amputation was $ 12 598 based on 2015/16 prices, and when adjusted to 2020, prices amounted to $ 16 157 per patient, whilst the mean cost per patient for lower limb amputation was $ 16 718 based on 2015/16 prices, and when adjusted to 2020 prices, amounted to $ 21 441 per patient. Conclusion: Hospital costs associated with diabetes related amputation varied by whether the patient was admitted to intensive care unit or not, and the major cost drivers were general ward costs, compensation of employees, and radiology services. A comprehensive audit of the referral process and care process at the facility level as well as technical efficiency analysis, is required to identify inefficiencies that could reduce hospital costs for managing diabetes complications.