Lifetime cost of chronic ulcers requiring hospitalization in Ontario, Canada: a population-based study

Objective — To determine the lifetime cost-of-illness of chronic ulcers from the perspective of the Ontario public healthcare payer.

Methods — We calculated healthcare costs for a cohort of individuals hospitalized for a diabetic foot ulcer, pressure ulcer or leg ulcer between 2005 and 2011 using Ontario administrative healthcare data. Lifetime costs for this cohort were estimated using phase-based costing methods. Net cost was determined by calculating the difference in lifetime costs between the chronic ulcer cohort and a matched non-chronic ulcer cohort. Matching was conducted using a combination of hard matching and propensity score methods. The chronic ulcer cohort represents all individuals residing in Ontario, Canada.

Results — A total of 7316 individuals with chronic ulcers were identified and matched with a non-chronic ulcer cohort (5583 diabetic foot ulcer, 1470 pressure ulcer, 262 leg ulcer). Lifetime net modeled cost of diabetic foot ulcer was $619,300 (95% CI $593,900–$642,800), for pressure ulcer $98,500 (95% CI $88,300–$109,100) and for leg ulcer $548,100 (95% CI $524,400–$569,500).

Conclusions — Chronic ulcers present a substantial economic burden to the healthcare system. Healthcare decision makers are encouraged to consider additional resources to preventative interventions for chronic ulcers to reduce downstream costs.