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Ann Endocrinol (Paris). 2018 Apr;79(2):67-74. doi: 10.1016/j.ando.2017.11.005. Epub 2018 Mar 12.

Cost of diabetic foot in France, Spain, Italy, Germany and United Kingdom: A systematic review.

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Trauma, orthopaedic surgery and wound healing unit, centre hospitalier Saint-Martin, 97150 Guadeloupe, France. Electronic address:
Division of diabetes, endocrinology and metabolism, CHRU de Pointe-Apitre, Pointe-A-Pitre, 97139 Guadeloupe, France.
Division of diabetes, endocrinology and metabolism, CHRU de Martinique, 97220 Martinique, France.
Wound healing unit, polyclinique guadeloupe, 97139 Guadeloupe, France.
Regional unit of hôpital épidémiologie, université François-Rabelais, 37000 Tours, France.
Regional heath agency, Saint-Martin et Saint-Barthélemy, 97113 Guadeloupe, France.
Health economics, institut Mines-Télécom, 75014 Paris, France.
Regional unit of hôpital épidémiologie, université François-Rabelais, 37000 Tours, France; EES Interdisciplinary Research Unit (Health Education & Ethics), François-Rabelais University of Tours, France.



Cost estimates for diabetic foot are available for developed countries based on cost data for different years. This study aimed to provide a comparison of the cost of diabetic foot in E5 (France, Spain, Italy, Germany, and the United Kingdom) and its characteristics across different conditions.


PubMed, Central and Embase databases were searched in February 2017 for English language publications. Bibliographies of relevant papers were also searched manually. Reviews and research papers from E5 regions reporting on cost of diabetic foot were included. Reported cost was converted to equivalent 2016 $ for comparison purposes. All the costs presented are mean cost per patient per year in 2016 $.


Nine studies were included in the analysis. The total cost of amputation ranged from $ 15,046 in 2001 to $ 38,621 in 2005. The direct cost of amputation ranged from $ 13,842 in 2001 to $ 83,728 during 2005-2009. Indirect cost of amputation was more uniform, ranging from between $ 1,043 to $ 1,442. The direct cost of gangrene ranged from $ 3,352 in 2003 to $ 8,818 in Germany. Although, for the same year, 2003, the cost for Spain was almost double that for Germany. The total cost of an uninfected ulcer was $ 6,174 in 2002, but increased to $ 14,441 in 2005; for an infected ulcer the cost increased from $ 2,637 to $ 2,957. The different countries showed variations in the components used to calculate the cost of diabetic foot.


The E5 incurs a heavy cost from diabetic foot and its complications. There is an unmet need for the identification of cost-cutting strategies, as diabetic foot costs more than major cardiac diseases.


Amputation; Cost; Coût; Diabetic foot; Foot ulcer; Gangrene; Gangrene: Amputation; Health economics; L’économie de la santé; Pied diabétique; Ulcère du pied

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