Environmental Valuation & Cost-Benefit News

Abstract:
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.

by Wolfgang Habacher MSc 1, Ivo Rakovac MSc, Evelyn Görzer MD, Waltraud Haas RsN, Robert J. Gfrerer PhD MPH, Paul Wach PhD Prof and Thomas R. Pieber MD
1. MSc, Health Management Researcher, Joanneum Research Forschungsgesellschaft mbH, Institute of Medical Technologies and Health Management, Graz, Austria; E-mail: wolfgang.habacher@joanneum.at
2. MSc, Statistician, Health Management Researcher, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Institute of Medical Technologies and Health Management, Graz, Austria
3. MD, Diabetologist, Department of Internal Medicine, Diabetes and Metabolism, Medical University Graz, Graz, Austria
4. RsN, Diabetes Nurse, Department of Internal Medicine, Diabetes and Metabolism, Medical University Graz, Graz, Austria
5. PhD MPH,General Manager, Human.technology. Styria GmbH, Graz, Austria
6. PhD Prof66Professor, Institute of Biomedical Engineering, Graz University of Technology, Graz, Austria and
7. MD Prof, Head of Institute of Medical Technologies and Health Management, Joanneum Research Forschungsgesellschaft MbH, Institute of Medical Technologies and Health Management, Graz, Austria and Medical Director, Graz University Clinics, Department of Internal Medicine, Diabetes & Metabolism, Medical University Graz, Austria

Journal of Evaluation in Clinical Practice
Volume 13, Issue 6; December, 2007; Pages 906-912
doi:10.1111/j.1365-2753.2006.00770.x
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2753.2006.00770.x?journalCode=jep