{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T22:30:11Z","timestamp":1792449011669,"version":"4.5.0"},"reference-count":22,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,3,21]],"date-time":"2024-03-21T00:00:00Z","timestamp":1710979200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001411","name":"Indian Council of Medical Research","doi-asserted-by":"publisher","award":["2022\u201005696"],"award-info":[{"award-number":["2022\u201005696"]}],"id":[{"id":"10.13039\/501100001411","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Wound Journal"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Diabetic foot ulcer is a debilitating complication of long\u2010standing diabetes mellitus. Patients lose their earning potential, face repeated hospitalizations, and are forced to bear heavy treatment costs. This places an enormous financial burden on the patients and their families. This study seeks to ascertain the out\u2010of\u2010pocket expenditure among these patients and correlate it with their risk factor profile. In this hospital\u2010based cross\u2010sectional study, a total of 154 patients with diabetic foot ulcers or amputations have been studied with an elaborate patient questionnaire and relevant clinical examinations. The costs incurred and the risk factors of the patients were analyzed for statistical association. The median total annual out\u2010of\u2010pocket expenditure for the management of diabetic foot ulcers among the study participants was found to be \u20b929\u2009775 (\u20b99650\u2013\u20b981\u2009120) ($378.14 [$122.56\u2013$1030.22]). Out of the total expenditure, 58.49% went towards direct medical costs, 5.64% towards direct non\u2010medical costs, and 35.88% for indirect costs. Medications, ulcer dressing and periodic debridement have accounted for 79.26% of direct medical costs. Transportation (61.37%) and patient's loss of income (89.45%) account for the major costs under the direct non\u2010medical and indirect cost categories, respectively. A high ulcer grade and area, long ulcer duration, and past history of ulcers have higher expenditure. Patients seeking treatment from private establishments and those engaged in professional\/skilled occupations have higher expenses. Adequate dressing of foot ulcers and proper footwear are associated with lower treatment expenditure. 68.8% of the participants have faced catastrophic expenditure due to treatment costs of diabetic foot ulcers. Adequate glycaemic control and proper foot care are necessary. Patients must seek medical care at the earliest in case of foot ulceration. Clinicians must provide proper wound care, institute effective antibiotics, and manage the complications. Government and insurance schemes are required to alleviate the patients' financial burden.<\/jats:p>","DOI":"10.1111\/iwj.14552","type":"journal-article","created":{"date-parts":[[2024,3,21]],"date-time":"2024-03-21T20:05:56Z","timestamp":1711051556000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Out\u2010of\u2010pocket expenditure among patients with diabetic foot ulcer in a tertiary care hospital of south India: A cross\u2010sectional study"],"prefix":"10.1111","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7532-9949","authenticated-orcid":false,"given":"Hariharan","family":"Seshadri","sequence":"first","affiliation":[{"name":"Madras Medical College  Chennai Tamil Nadu India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3768-3218","authenticated-orcid":false,"given":"Venkatesh","family":"Karthikeyan","sequence":"additional","affiliation":[{"name":"Department of Community and Family Medicine All India Institute of Medical Sciences  Patna Bihar India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5792-0906","authenticated-orcid":false,"given":"Malavika","family":"Rudrakumar","sequence":"additional","affiliation":[{"name":"St. John's Medical College  Bangalore Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2202-9208","authenticated-orcid":false,"given":"Prashanth","family":"Seshadri","sequence":"additional","affiliation":[{"name":"Madras Medical College  Chennai Tamil Nadu India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1867-9384","authenticated-orcid":false,"given":"Damodaran","family":"Vasudevan","sequence":"additional","affiliation":[{"name":"Institute of Community Medicine, Madras Medical College  Chennai Tamil Nadu India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1601-3630","authenticated-orcid":false,"given":"Vasuki","family":"Ranganathan","sequence":"additional","affiliation":[{"name":"Institute of Diabetology, Madras Medical College  Chennai Tamil Nadu India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7935-7333","authenticated-orcid":false,"given":"Tirth","family":"Dave","sequence":"additional","affiliation":[{"name":"Bukovinian State Medical University  Chernivtsi Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0914-1056","authenticated-orcid":false,"given":"Victor","family":"Ghosh","sequence":"additional","affiliation":[{"name":"Andhra Medical College  Visakhapatnam Andhra Pradesh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8763-2171","authenticated-orcid":false,"given":"Vadada","family":"Ramsai","sequence":"additional","affiliation":[{"name":"Osmania Medical College  Hyderabad Telangana India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6723-5865","authenticated-orcid":false,"given":"Balakrishnan","family":"Kamaraj","sequence":"additional","affiliation":[{"name":"Madurai Medical College  Madurai Tamilnadu India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,3,21]]},"reference":[{"key":"e_1_2_11_2_1","volume-title":"IDF Diabetes Atlas","author":"International Diabetes Federation","year":"2021"},{"key":"e_1_2_11_3_1","unstructured":"World Health Organization.The top 10 causes of death. Accessed August 14 2023.http:\/\/www.who.int\/en\/news-room\/fact-sheets\/detail\/the-top-10-causes-of-death"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.4103\/ijo.IJO_1627_21"},{"issue":"6","key":"e_1_2_11_5_1","first-page":"504","article-title":"Prevalence of micro and macrovascular complications and their risk factors in type\u20102 diabetes mellitus","volume":"62","author":"Agrawal RP","year":"2014","journal-title":"J Assoc Physicians India"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.8636"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.5005\/jp\u2010journals\u201010040\u20101052"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2017.08.489"},{"key":"e_1_2_11_9_1","unstructured":"World Health Organization.Global report on diabetes. 2016. Accessed August 14 2023.https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/204871\/9789241565257_eng.pdf?sequence=1&isAllowed=y"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/2042018817744513"},{"issue":"2","key":"e_1_2_11_11_1","first-page":"102","article-title":"The costs of treating long\u2010term diabetic complications in a developing country: a study from India","volume":"61","author":"Kumpatla S","year":"2013","journal-title":"J Assoc Physicians India"},{"key":"e_1_2_11_12_1","first-page":"530","article-title":"Foot care economics\u2013cost burden to diabetic patients with foot complications: a study from southern India","volume":"49","author":"Shobhana R","year":"2001","journal-title":"J Assoc Physicians India"},{"issue":"8","key":"e_1_2_11_13_1","first-page":"677","article-title":"Assessment of economic burden for the management of diabetic foot ulcer in patients attending tertiary care teaching hospital, Davangere","volume":"8","author":"Angadi N","year":"2019","journal-title":"Int J Med Sci Public Health"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40200-018-0344-8"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.12669\/pjms.293.3473"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.18203\/2320\u20106012.ijrms20191323"},{"key":"e_1_2_11_17_1","unstructured":"vanNettenJJ.Definitions and criteria for diabetic foot disease \u2013 IWGDF guidelines. 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