The Diabetic Foot. Costs, health economic aspects, prevention and quality of life.

The overall aims were to investigate the economic consequences of foot complications in diabetic patients, to measure the influence of diabetic foot complications on health-related quality of life (HRQL), and to analyse the cost-effectiveness of interventions to prevent foot ulcers and lower extremity amputations (LEA). The economic consequences of foot ulcers and LEA are large both in a short and a longer perspective. Seventy-six percent of the total short term costs for LEA occurred after amputations had been performed and before complete healing had been achieved. The major long-term costs for the 3 years following healing were related to increased home care and social service, especially for patients who had undergone LEA. The most important determinants of the cost of an ulcer with deep foot infection were wound healing duration and repeated surgery. Costs of inpatient care and topical treatment represent a substantial part of the total costs for both primary healing and healing with minor or major amputation. The frequency of dressing changes and velocity of healing together with costs of material, staff and transportation are important factors for the total topical treatment costs. The Swedish Inpatient Registry is valid regarding completeness of registered discharges for patients who have been treated for foot ulcers, but the database is less valid with reference to reported diagnoses. Cost analyses of diabetic foot complications will be seriously underestimated when based exclusively on primary diagnosis from the database. Patients with current foot ulcers value their HRQL significantly lower than primary healed patients. HRQL is reduced in patients who have undergone major amputations. An intensified prevention strategy including patient education, foot care and footwear is cost-effective or cost saving if the risk for foot ulcers and lower extremity amputations could be reduced by 25%. The strategy would be cost-effective or cost saving in all patients with diabetes, except in those without specific risk factors for development of these complications