What Data From a Pilot Study in Germany Tells Us About the Global Cost of CLTI
Clinica Luganese Moncucco, Lugano, Switzerland
One of Wednesday morning's presentations at the Amputation Prevention Symposium in Boston shifted the discussion from clinical outcomes to the broader economic impact of chronic limb-threatening ischemia (CLTI). Jos C. van den Berg, MD, PhD, of Clinica Luganese Moncucco in Lugano, Switzerland, presented findings from a pilot health economic analysis conducted in Germany that provides an important framework for understanding the true societal cost of CLTI and may serve as a model for future analyses across Europe and globally.
Germany was selected because of its relatively better data availability, but Dr van den Berg emphasized that CLTI remains an understudied disease, even in Germany. The pilot study was designed to establish a methodology capable of estimating not only direct healthcare expenditures but also the often-overlooked indirect costs associated with productivity loss and diminished quality of life. Studies of the economic burden of disease offer valuable insights into the financial impact of illnesses on society, helping to quantify the costs borne by healthcare systems, patients, and the broader economy. By examining the direct medical costs, indirect productivity losses, and quality-of-life impacts associated with specific conditions, these analyses provide a comprehensive view of the resources that diseases demand and the economic strain they impose.
Using a comprehensive health economic model, investigators estimated the total annual economic burden of CLTI in Germany to be approximately €9 billion (US $10.3 billion). Direct medical costs accounted for approximately €5 billion (US $5.7 billion), driven largely by revascularization procedures, amputations, and ongoing medical care, while productivity losses contributed nearly €4 billion (US $4.6 billion). A notable finding was that unpaid work (including caregiving and household responsibilities) represented approximately €3 billion (US $3.4 billion) of these indirect costs, with women bearing a disproportionate share of that burden.
The analysis also highlighted the outsized impact of diabetes on healthcare expenditures. Patients with diabetes accounted for the largest proportion of direct medical costs, reinforcing the close relationship between diabetes, CLTI, and adverse limb outcomes. Additionally, the study estimated that nonhealing ulcers alone generate an additional €1.6 billion (US $1.8 billion) in costs, illustrating how delayed wound healing substantially amplifies the financial burden on healthcare systems.
Beyond economics, the presentation underscored the human impact of CLTI. Investigators estimated a loss of 157,477 quality-adjusted life years (QALYs), reflecting not only reduced survival but also significant impairments in mobility, chronic pain, independence, and overall quality of life. Older adults, particularly those with diabetes, experienced the greatest burden, highlighting populations that may benefit most from earlier diagnosis and more aggressive preventive strategies.
Dr van den Berg concluded that the results of this study underscore the financial burden of CLTI beyond its direct health implications. Earlier intervention, preventive measures, and long-term care strategies have the potential to improve both health and productivity.
