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

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