DIABETIC FOOT ULCERS IN A MULTIDISCIPLINARY SETTING - AN ECONOMIC-ANALYSIS OF PRIMARY HEALING AND HEALING WITH AMPUTATION

Objectives. To perform an economic analysis of primary healing and hea ling with amputation in diabetic patients with foot ulcers. Design. A retrospective economic analysis based on a prospective study of consec utively presenting diabetic patients admitted to the Department of Int ernal Medicine because of foot ulcer. Setting. A multidisciplinary foo t-care team. Subjects. A total of 314 consecutively presenting diabeti c patients with foot ulcers. Forty patients died before healing occurr ed. In those patients who healed primarily (n = 197) or after amputati on (n = 77), a retrospective economic analysis was performed. Interven tions. All patients were treated by a multidisciplinary foot care team consisting of diabetologist, orthopaedic surgeon, diabetes nurse, pod iatrist and orthotist both as in- and out-patients. The patients were followed by the team from admittance until final outcome, i.e. primary healing or healing with amputation or death. Main outcome measures. D ata from both the prospectively collected patient material and from pa tient records were used to estimate the cost for hospital care, antibi otics, surgery, out-patient care, staff attendance, drugs and material for ulcer dressings, and orthopaedic appliances. Results. The total c osts were SEK 51000 (3000-808000) for patients with primary healing an d SEK 344000 (27000-992000) for healing with amputation. Costs for in- patient care were 37% of total average costs for primary healing and 8 2% for patients with amputation. The costs for topical treatment of th e ulcers in out-patient care were 45% of the total average cost for pr imary healed and 13% for patients who healed with amputation. The cost s for products used for ulcer dressings were 21% of total costs for to pical treatment, i.e. 9% and 3% of total average costs for primary hea ling and healing with amputation, respectively. Costs for visits to th e foot care team, antibiotics and orthopaedic appliances were low in r elation to total costs. Conclusion. Treatment of diabetic patients wit h foot ulcers in a multidisciplinary system was associated with relati vely low costs. Healing with amputation was associated with high costs mainly due to multiple and extended hospitalization. These findings i ndicate the potential cost savings of preventive and multidisciplinary foot care.