Jos van den Berg, MD, PhD, Highlights the Growing Economic Burden of CLTI in Europe
Clinica Luganese Moncucco, Lugano, Switzerland
During Wednesday morning’s “CLTI in 2025” session, interventional radiologist Jos van den Berg, MD, PhD, from the Clinica Luganese Moncucco in Lugano, Switzerland, delivered a presentation titled “The Economic Burden of CLTI in Europe.” Dr van den Berg described chronic limb-threatening ischemia (CLTI) as a mounting clinical and economic challenge across the continent.
The presentation opened with an overview of persistently high amputation rates across Europe—tracked in successive Health at a Glance (HAAG) reports from 2019 to 2023—alongside a parallel increase of incidence of diabetes, a principal driver of CLTI. Diabetes prevalence data from the Diabetes Atlas underscored the escalating risk profile of European populations.
To quantify the economic toll, the research team chose Germany as a pilot country because of its data availability and the expectation that insights could be extrapolated to other European systems. Despite this advantage, Dr van den Berg noted, CLTI remains an understudied disease, even in Germany, highlighting pervasive data gaps that complicate policy planning.
Germany is home to approximately 1.8 million people living with CLTI, a figure propelled by aging demographics and diabetes prevalence. Clinically, many of these patients progress to major interventions such as revascularization or amputation, procedures that heavily influence direct medical spending.
Using a comprehensive health-economic model, investigators captured both direct medical costs (hospitalizations, procedures, wound care) and indirect productivity losses (paid and unpaid labor), with additional accounting for lost quality-adjusted life-years (QALYs).
Key findings from the German case study included a total yearly burden of approximately €9 billion in combined direct and indirect costs; direct healthcare costs of approximately €5 billion, driven largely by patients with diabetes; productivity losses of nearly €4 billion, of which about €3 billion stems from unpaid work, disproportionately affecting women; ulcer-related add-on costs (nonhealing ulcers alone impose an extra €1.6 billion annually); health-related quality of life (an estimated 157,477 QALYs are lost each year, reflecting chronic pain, mobility limitations, and reduced life expectancy); and a finding that women shoulder a larger share of unpaid-productivity losses, revealing an often-overlooked social dimension of CLTI care.
Dr. van den Berg concluded that the findings underscore the substantial financial burden of the disease, extending beyond its direct health implications, and called for early intervention, preventive measures, and long-term care strategies to curb both costs and disability.
