SLR - August 2009 - Sally Ann Warren
Reference:
Habib, S.H., Biswas, K.B., Akter, S., Saha, S., Ali, L. (2009). Cost-effective analysis of medical intervention in patients with early detection of diabetic foot in a tertiary care hospital in Bangladesh. Journal of Diabetes Complications.
Scientific Literature Reviews
Reviewed by: Sally Ann Warren, DPM
Residency Program: OCPM-UHHS Richmond Medical Center
Podiatric Relevance:
This study displayed financial ramifications of poor management of the diabetic foot, with medical cost significantly increased in relation to complications, and a reduction in
cost noted with proper management.
Methods:
200 patients were randomly selected. Of the 200, 100 were late in detection with poormanagement (LDF) and 100 were early detected with proper management (EDF). The degree and extent of complications, treatment outcomes, clinical effectiveness of interventions and direct, indirect, and incremental cost of complications were calculated. Cost included drugs, hospitalizations, diagnostics and visits. Inclusion criteria consisted of patients having been diagnosed as diabetic for at least 2 years and having completed at least 3 follow up visits.
Results:
Average annual cost was $17893 in LDF and $8953 in EDF. Cost per patient was $189 in LDF and $79 in EDF. Drugs were $10419 in LDF and $3054 in EDF. Hospitalization fees were $4914 in LDF and $2739 in EDF. Diagnostic expenditures were $1953 in LDF and $1631 in EDF. Visits to doctors cost $1580 in LDF and $556 in EDF. The annual medical costs increased with an increase in the number of complications from $1320 to $2296 to $3989 in LDF with one, two and more than two complications and from $917 to $1556 to $2372 in the EDF group.
Conclusions:
Early detection and prevention from amputation are cost-effective and cost saving. The data also showed that diabetic foot care is high in a developing country even when
calculated by a social welfare organization without profit motive. Data also shows that diabetic foot care in Bangladesh is a substantial financial burden in the form of
amputation.