Matt Hickman is co-director with Charles Beck (UK Health Security Agency) and Katy Turner (UK Health Security Agency Health England) of the NIHR Health Protection Research Unit in Evaluation and Behavioural Science and a member and co-investigator of NIHR School of Public Health Research and DeCIPHER (UKCRC Public Health Centre of Excellence for the Development and Evaluation of Complex Interventions for Public Health Improvement).

His research programme focuses on infectious disease control and the epidemiology and public health consequences of drug use – with active research grants on prevention of Hepatitis C Virus, drug related mortality, and alcohol related harms.

Abstract

Trends in the burden and cost of injecting-related hospitalisations due to limb- and vascular-related complications in England 2014–2023

Aims: Injecting site skin- and soft-tissue infections can lead to limb- and vascular-related complications and major surgical intervention. We aimed to estimate the cost and burden of these complications and how much is related to injecting drug use – using NHS hospital episode statistics data in England.

Methods: We used NHS hospital episode statistics data for 2014–2023 for people aged 15–64. We used diagnostic and operation codes to define limb- and vascular-related complications and stratified these hospital episodes by those with and without drug-related admission codes as a proxy for injecting drug use. NHS cost data were applied to the hospital episode data using the NHS Healthcare Resource Group 4+ Local Payment Grouper software.

Results: The estimated cost of these 1,498,462 limb- and vascular-related hospitalisations was £13.6 billion. 46,660 (3.1%) had drug use-related codes, costed at £795.5 million (5.5%) overall, with annual costs increasing from £43.4 million to £105.6 million over 2014-2023. Age-stratified median costs per spell were higher for drug-related than non-drug-related hospitalisations: £4,144 vs £1,973 (age 15-35), £4,866 vs £2,219 (age 36–50), and £6,294 vs £3,009 (age 51–64).

Conclusions: Assuming 2023’s annual costs of £105.6 million for these drug-related complications over the next ten years, this would cost the NHS over £1 billion. However, these costs have been increasing and are likely an underestimate due to under-recording of drug-use. There needs to be greater attention and urgency given to harm reduction and interventions to prevent and treat skin- and soft-tissue infections among people who inject drugs.