Resource utilisation and costs associated with the treatment of diabetic foot ulcers. Prospective data from the Eurodiale Study

Abstract

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, Diabetologia (2008) 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 inhospital stay, reducing the number and duration of hospital admissions seems an attractive option to decrease costs in diabetic foot disease.

Prognosis of the infected diabetic foot ulcer: a 12‐month prospective observational study

“…The participants in the present study with a clinically suspected diabetic foot ulcer infection had poorer outcomes than reported in previously published studies, which enrolled people with various types of diabetic foot ulcers 5, 13, 14, 15. We found a 12‐month incidence of healing of 44.5%, while Prompers et al .…”

“…A lower perfusion grade suggests the presence of peripheral arterial disease, which previous studies have shown to be an important predictor of poor outcomes (i.e. lack of healing and lower extremity amputation) in people with a diabetic foot ulcer 5, 13, 14, 15. In the present study, among the five PEDIS domains, perfusion (indicating peripheral arterial disease) was shown to be the only independent predictor of healing.…”

“…In addition, we found that during 12 months of follow‐up for their infected diabetic foot ulcer, 17.4% of our participants underwent at least partial lower extremity amputation and 15.1% died, compared with 22% for amputation and 6% deaths in the study by Prompers et al . 5 and 5.9% for amputation or death (reported as combined) in the study by Ince et al . 13 These differences may have arisen because we specifically recruited people with a suspected infected diabetic foot ulcer, whereas Prompers et al .…”

“…We found a 12‐month incidence of healing of 44.5%, while Prompers et al . 5, Ince et al . 13 and Jeffcoate et al .…”

“…Prospective data on clinical outcomes of infected diabetic foot ulcer are scarce. Two large inception cohort studies 5, 13, 14, 15 assessed factors associated with diabetic foot ulcer healing, but neither specifically recruited people with infected ulcers and both were limited to specialist centres. Ince et al .…”