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OBJECTIVES: To estimate the cost of management of diabetic foot ulcers and the standards of foot-care practices.
METHODS: Patients admitted with diabetic foot ulcers (DFU) to the University Surgical Unit, Colombo South Teaching Hospital during 6 months were audited. Costs were obtained from the Medical Supplies Division, Central Blood Bank, Director General of Laboratory Services and 3 leading private hospitals.
RESULTS: 144 (4.3% of admissions) diabetic patients occupied 10.1% of hospital beds. Average stay was 10.9 days. 55 daily-paid workers lost Rs.1076.36 for each admission. Each family has spent Rs.1811.60. The State has spent Rs.14 936 during the hospital stay of each patient. Majority of 61.8%, DFUs started as preventable minor trauma. 48% knew the importance of foot-care but practices remained poor. Worst affected were the patients followed up at peripheral units. Only 11.1% feet were completely assessed by a doctor.
CONCLUSIONS: DFUs have a serious impact on patients and the State. Standards of foot-care remain poor among patients. A well planned foot-care program will be highly cost-effective.
Way short of the often quoted 20% of admission and still higher than what I reported of <1% a number of years ago.
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Sure, though Craig the important cost statistic is the bed stay days of 10.1% and days of stay of10.9 days, especially with the 4.3% of admissions figure taken into account.
When this is copmpared to other illnesses especially in the UK (where they get you out of hospital very early sometimes too early) it is very high. dont forget diabetes still only accounts for 4-6 % of the population.....
There is no doubt about the magnitude of the problem. I traced back the source of the commonly quoted statement that diabetic foot complications make up 20% of all admission to hospital in those with diabetes to a comment in the preface in an earlier edition of Levin's --- there was never any data to support it, but got quoted so many times it became gospel.
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Rationale, aims and objectives
The diabetic foot is a common late complication among diabetic patients and due to its consequences an important financial burden for society. Intensified treatment has proved to reduce amputation rates, but in Austria so far no data have been available about financial implications and long-term effects of intensified treatment. The objective was to retrieve cost data for intensified treatment of diabetic foot ulcers and to estimate the long-term outcome.
Methods
A retrospective data analysis of 119 ulcers was done to get outcomes and costs for intensified treatment in a specialized outpatient hospital department in an Austrian setting. One-year results were categorized according to the San Antonio wound classification. Using a Markov model upon these data, long-term outcomes and costs for intensified treatment and for standard care were calculated.
Results
Costs for intensified treatment until healing vary from €1071 (range: 99-4089) per case to €7844 (range: 104-25 615) depending on the lesion's grade. One-year healing rates are 85.2% for grade A and 71.7%, 84.6% and 33.3% for the grades B, C and D respectively. The model-based comparison for treatment costs shows a cost reduction of 29.8% per patient year in grade A ulcerations and 49.7% in grade D for intensified versus standard treatment due to lower amputation rates.
Conclusions
These results are the first cost data for diabetic foot care in Austria and demonstrate the advantages of intensified care over standard care in terms of patient-oriented outcome and financial impact pleading for the implementation of specialized foot care facilities and referral guidelines to standardize and improve treatment.
Resource utilisation and costs associated with the treatment of diabetic foot ulcers. Prospective data from the Eurodiale Study.
Prompers L, Huijberts M, Schaper N, Apelqvist J, Bakker K, Edmonds M, Holstein P, Jude E, Jirkovska A, Mauricio D, Piaggesi A, Reike H, Spraul M, Acker KV, Baal SV, Merode FV, Uccioli L, Urbancic V, Tennvall GR. Diabetologia. 2008 Jul 22. [Epub ahead of print]
Quote:
AIMS/HYPOTHESIS: The aim of the present study was to investigate resource utilisation and associated costs in patients with diabetic foot ulcers and to analyse differences in resource utilisation between individuals with or without peripheral arterial disease (PAD) and/or infection.
METHODS: Data on resource utilisation were collected prospectively in a European multicentre study. Data on 1,088 patients were available for the analysis of resource use, and data on 821 patients were included in the costing analysis. Costs were calculated for each patient by multiplying the country-specific direct and indirect unit costs by the number of resources used from inclusion into the study up to a defined endpoint. Country-specific costs were converted into purchasing power standards.
RESULTS: Resource use and costs varied between outcome groups and between disease severity groups. The highest costs per patient were for hospitalisation, antibiotics, amputations and other surgery. All types of resource utilisation and costs increased with the severity of disease. The total cost per patient was more than four times higher for patients with infection and PAD at inclusion than for patients in the least severe group, who had neither.
CONCLUSIONS/INTERPRETATION: Important differences in resource use and costs were found between different patient groups. The costs are highest for individuals with both peripheral arterial disease and infection, and these are mainly related to substantial costs for hospitalisation. In view of the magnitude of the costs associated with in-hospital stay, reducing the number and duration of hospital admissions seems an attractive option to decrease costs in diabetic foot disease.
The personal cost of diabetic foot disease in the developing world—a study from Pakistan
S. M. Ali, A. Fareed, S. M. Humail, A. Basit, M. Y. Ahmedani, A. Fawwad, Z. Miyan Diabetic Medicine Volume 25 Issue 10 (October 2008)
Quote:
Aims The aim of the present study was to estimate the direct cost of treatment of diabetic foot ulcer at a tertiary care hospital in Karachi, Pakistan in order to assess the extent of the economic burden which it imposes.
Methods Out of 383 patients seen at Foot clinic of Baqai Institute of Diabetology and Endocrinology (BIDE), records of 214 patients were analyzed while 169 patients left against medical advice (LAMA). The UT system was used to classify ulcer types. Information was retrieved on resource consumption (physician services, chiropody, investigations, medicines, hospital care and surgical procedures). Interventions were summed and multiplied by the unit price of each resource, using charges levied at BIDE in the year 2005, in order to calculate the total cost of treatment.
Results 64% were male, with mean age 52.7 ± 10.2 years. Mean duration of diabetes was 16.2 ± 6.6 years. Majority (62.1%) were Grade 2 ulcer. The estimated direct cost of management increased from 2700 ± 250 rupees (£21 ± 2) for a UT grade 1, stage B ulcer to 37 415 ± 24 125 rupees (£288 ± 186) for UT grade 2, stage D and 49 058 ± 30 144 rupees (£378 ± 232) for UT grade 3, stage D ulcers, respectively. The mean direct cost of major amputation (transtibial or transfemoral) was 46 182 ± 30 742 (£356 ± 237) whilst the cost of a minor amputation was 50 494 ± 30 488 rupees (£389 ± 235).
Conclusions This retrospective study, despite having limitations, is important for a developing world country with limited data on health economics. Further larger scale prospective studies are needed to address this issue in more detail.
The consensus is that a multidisciplinary approach for patients with diabetic foot ulcer is effective in reducing the number of leg amputations. Concern remains, however, about cost and health-related quality of life issues. From August 2005 to March 2007, a multidisciplinary diabetic foot protocol (DFP) was used at the authors' teaching hospital.There were devices to reduce pressure on the foot.After healing, there were custom-fabricated orthoses and footwear, and monitoring of progress in ambulation. All subjects were educated about diabetic foot disease and its complications and prevention.They were also instructed to call and visit the hospital if there were any signs of new lesions.This study compared responses to the short form 36 questionnaires (SF-36) about health-related quality of life and the cost of medical care for patients receiving DFP care from August 2005 to March 2007 and those who had standard care from August 2003 to July 2005.There were 56 and 40 diabetic foot ulcer patients on DFP and standard care packages, respectively. Their gender distribution and mean age were similar. The average total cost of DFP patients was significantly lower than that for standard care patients ($1127.02 and $1824.58, respectively, P = .02). DFP patients had significantly higher scores on the SF-36 for both the physical and mental health dimensions than standard care patients. It was concluded that DFP was less expensive and gave patients a better quality of life, compared to standard care. On the basis of this finding, DFP should be used by every hospital to improve outcomes for patients with diabetic foot ulcer.
Costs of diabetic foot complications
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