Cost analysis of flap reconstruction for diabetic foot ulcers in the NHS: A single-centre study

Diabetic foot disease costs NHS England up to £1 billion annually. Flap reconstruction can offer limb salvage in patients with diabetic foot ulcers (DFUs), but its cost-effectiveness remains unclear. This study evaluates the impact of flap reconstruction for DFU on direct secondary health costs in a single UK centre.

A retrospective cohort cost analysis was conducted for patients undergoing flap reconstruction for DFU that have failed conservative management between 2019 and 2024. Data on hospital admissions, surgery, outpatient care, podiatry, and Rapid Response and Intermediate Care (RRIC) services were collected from one year pre-op to two years post-op. Cost estimates were obtained from institutional financial records, using routinely collected NHS clinical coding data.

Thirteen reconstructions (8 free, 5 locoregional) were performed. Mean age was 60.5 years (range 31-82). There were 0 complete and 2 partial flap failures (no further flap reconstruction required). Median length of stay was 18 days (range 2-58). All limbs were salvaged at 1 year; by year 2, there was 1 amputation and 0 deaths. Median direct cost of the reconstruction episode was £25,250 (IQR £21,581.50-£36,969.50). Median direct costs during the year before surgery were £21,519 (IQR £3936-£24,376), falling to £4487 in year 1 and £954 in year 2 post-operatively. Median hospital admission days were: 18 in the year before reconstruction, and 1 and 0 in year 1 and year 2 after reconstruction, respectively.

There is a lack of evidence regarding cost-effectiveness of salvage reconstruction for DFUs. In appropriately selected non-healing DFU's, flap reconstruction appears cost-effective and significantly reduces days of hospital admissions.