Assessment of the Comprehensive Score for Financial Toxicity (COST) among People with Diabetic Foot Ulcers at a Tertiary Care Centre in South India

Abstract

Background

Literature on Financial Toxicity (FT) using the Comprehensive Score for Financial Toxicity – Functional Assessment of Chronic Illness Therapy (COST-FACIT) among people with diabetic foot ulcers (DFUs) is unavailable in India. This study assessed FT among people with DFUs using the COST measure.

Materials and Methods

A total of 234 participants with DFUs were included from April-June 2025 in a tertiary care diabetes center and administered with COST-FACIT and sleep health (RU-SATED) questionnaires. Demographic, clinical, socio-economic status (SES), biochemical, co-morbidities and complications, cost of illness were recorded. Multivariable logistic regression was performed to identify predictors of FT.

Results

Around 85% of the participants had FT in which 15.8% experienced high FT. Lower socio-economic group recorded the lowest COST score (15 ± 6.5). Nearly one-third underwent minor (28.2%) and major (3.8%) amputations. DFU treatment expenses included inpatient costs: ₹98,167 ($1180), medications: ₹6869 ($83), offloading devices: ₹5374 ($65), and indirect cost: ₹4604 ($55). Cost coping behaviours identified were money borrowed (49.6%) and selling belongings (39.7%). Individuals with higher FT reported poor sleep health. Lower SES (AOR=24.9, p < 0.001), DFU duration>3years (AOR=2.3, p = 0.024), delayed doctor's visit (AOR=4.4, p = 0.048) and revascularization procedure (AOR=3.2, p = 0.014) were significant predictors of higher FT.

Conclusion

Around 85% of individuals with DFUs experienced FT. Early foot screening, social and health protection schemes, and appropriate policy measures would possibly alleviate high FT.