title: The personal cost of diabetic foot disease in the developing world--a study from Pakistan.
abstract: OBJECTIVE
  The aim of the present study was to estimate the direct cost of treatment of diabetic foot ulcer at a tertiary care hospital in Karachi, Pakistan in order to assess the extent of the economic burden which it imposes.
  
  
  METHODS
  Out of 383 patients seen at Foot clinic of Baqai Institute of Diabetology and Endocrinology (BIDE), records of 214 patients were analyzed while 169 patients left against medical advice (LAMA). The UT system was used to classify ulcer types. Information was retrieved on resource consumption (physician services, chiropody, investigations, medicines, hospital care and surgical procedures). Interventions were summed and multiplied by the unit price of each resource, using charges levied at BIDE in the year 2005, in order to calculate the total cost of treatment.
  
  
  RESULTS
  64% were male, with mean age 52.7 +/- 10.2 years. Mean duration of diabetes was 16.2 +/- 6.6 years. Majority (62.1%) were Grade 2 ulcer. The estimated direct cost of management increased from 2700 +/- 250 rupees (21 +/- 2 pounds) for a UT grade 1, stage B ulcer to 37,415 +/- 24,125 rupees (288 +/- 186 pounds) for UT grade 2, stage D and 49,058 +/- 30,144 rupees (378 +/- 232 pounds) for UT grade 3, stage D ulcers, respectively. The mean direct cost of major amputation (transtibial or transfemoral) was 46,182 +/- 30,742 ( 356 +/- 237 pounds) whilst the cost of a minor amputation was 50,494 +/- 30,488 rupees (389 +/- 235 pounds).
  
  
  CONCLUSIONS
  This retrospective study, despite having limitations, is important for a developing world country with limited data on health economics. Further larger scale prospective studies are needed to address this issue in more detail.
authors.affiliation: Baqai Institute of Diabetology and Endocrinology, Baqai Medical University Hospital, Karachi, Pakistan. esearch@bideonline.com
authors.forename: S M
authors.initials: SM
authors.lastname: Ali
authors.forename: A
authors.initials: A
authors.lastname: Fareed
authors.forename: S M
authors.initials: SM
authors.lastname: Humail
authors.forename: A
authors.initials: A
authors.lastname: Basit
authors.forename: M Y
authors.initials: MY
authors.lastname: Ahmedani
authors.forename: A
authors.initials: A
authors.lastname: Fawwad
authors.forename: Z
authors.initials: Z
authors.lastname: Miyan
mesh_terms: D000328:Adult; D000671:Amputation, Surgical / Q000191:economics; D017281:Cost of Illness; D017719:Diabetic Foot / Q000191:economics* / Q000628:therapy; D005260:Female; D006792:House Calls / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D012189:Retrospective Studies