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J Wound Care. 2019 May 2;28(5):261-266. doi: 10.12968/jowc.2019.28.5.261.

Methodological approaches for assessing the cost of diabetic foot ulcers: a systematic literature review.

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PhD Scholar, Royal College of Surgeons in Ireland, Dublin.
Senior Lecturer, Royal College of Surgeons in Ireland, Bahrain.
Senior Lecturer, Graduate Entry Medical School, University of Limerick, Limerick.
Director of Research, Senior Lecturer, Royal College of Surgeons in Ireland, Dublin.
Registrar, MCh Scholar, Royal College of Surgeons in Ireland, Dublin.
Professor of Nursing, Head of Department, Royal College of Surgeons in Ireland, Dublin.
Director of Healthcare Outcomes Research Centre, Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, Dublin.



To evaluate the methodological approaches used to assess the cost consequences of diabetic foot ulcers (DFUs) in published scientific papers.


A systematic literature search was conducted in PubMed, Embase, Scopus, Web of Science and CINAHL. English language papers reporting on the cost of DFUs were identified. Additionally, bibliographies were inspected to identify other relevant cost studies. Following the PRISMA guidance, the review identified the study design, epidemiological approach, analytical perspective and data collection approach in each of the included studies.


Relatively few studies of the cost consequences of DFUs were found (n=27). Most studies were conducted in Western countries with only five studies from countries in Asia and Africa. The identified studies used different study designs, epidemiological approaches, data collection strategies, and data sources, which in turn made a systematic comparison of cost estimates difficult. Detailed descriptions of the applied costing method and other methodological aspects were often limited or absent. Many studies only reported costs from a health-care payer's perspective and disregarded the costs to patients, their families and wider society.


The costs of DFUs have been assessed using a wide range of different methodological approaches often restricted to the healthcare payer's perspective. Therefore, the cost analyses may fail to consider the true societal costs of DFUs.


burden of disease; cost analysis; diabetes mellitus; diabetic foot ulcers; methodology; review

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