A model to analyse costs and benefit of intensified diabetic foot care in Austria.
OBJECTIVE
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 euro 1071 (range: 99-4089) per case to euro 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.
Habacher
Wolfgang
W
Joanneum Research Forschungsgesellschaft mbH, Institute of Medical Technologies and Health Management, Graz, Austria. wolfgang.habacher@joanneum.at
Rakovac
Ivo
I
Görzer
Evelyn
E
Haas
Waltraud
W
Gfrerer
Robert J
RJ
Wach
Paul
P
Pieber
Thomas R
TR
D000368:Aged; D000553:Ambulatory Care / Q000191:economics; D000671:Amputation, Surgical / Q000191:economics; D001317:Austria; D001424:Bacterial Infections / Q000191:economics; D015331:Cohort Studies; D003363:Cost Control; D003362:Cost-Benefit Analysis; D017719:Diabetic Foot / Q000145:classification / Q000191:economics* / Q000628:therapy; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007511:Ischemia / Q000191:economics; D008137:Longitudinal Studies; D008297:Male; D008390:Markov Chains; D018803:Models, Economic; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology