The costs of diabetic foot: The economic case for the limb salvage team

Vickie R. Driver, Matteo Fabbi, Lawrence A. Lavery, Gary Gibbons

Research output: Contribution to journalArticle

164 Citations (Scopus)

Abstract

Background: In 2007, the treatment of diabetes and its complications in the United States generated at least $116 billion in direct costs; at least 33% of these costs were linked to the treatment of foot ulcers. Although the team approach to diabetic foot problems is effective in preventing lower extremity amputations, the costs associated with implementing a diabetic foot care team are not well understood. An analysis of these costs provides the basis for this report. Results: Diabetic foot problems impose a major economic burden, and costs increase disproportionately to the severity of the condition. Compared with diabetic patients without foot ulcers, the cost of care for patients with a foot ulcer is 5.4 times higher in the year after the first ulcer episode and 2.8 times higher in the second year. Costs for the treatment of the highest-grade ulcers are 8 times higher than for treating low-grade ulcers. Patients with diabetic foot ulcers require more frequent emergency department visits, are more commonly admitted to hospital, and require longer length of stays. Implementation of the team approach to manage diabetic foot ulcers within a given region or health care system has been reported to reduce long-term amputation rates from 82% to 62%. Limb salvage efforts may include aggressive therapy, such as revascularization procedures and advanced wound healing modalities. Although these procedures are costly, the team approach gradually leads to improved screening and prevention programs and earlier interventions, and thus seems to reduce long-term costs. Conclusions: To date, aggressive limb preservation management for patients with diabetic foot ulcers has not usually been paired with adequate reimbursement. It is essential to direct efforts in patient-caregiver education to allow early recognition and management of all diabetic foot problems and to build integrated pathways of care that facilitate timely access to limb salvage procedures. Increasing evidence suggests that the costs for implementing diabetic foot teams can be offset over the long-term by improved access to care and reductions in foot complications and in amputation rates.

Original languageEnglish (US)
JournalJournal of Vascular Surgery
Volume52
Issue number3 SUPPL.
DOIs
StatePublished - Sep 2010

Fingerprint

Limb Salvage
Diabetic Foot
Economics
Costs and Cost Analysis
Foot Ulcer
Amputation
Ulcer
Patient Education
Diabetes Complications
Health Care Costs
Wound Healing
Caregivers
Hospital Emergency Service
Foot
Lower Extremity
Length of Stay
Patient Care
Therapeutics
Extremities
Delivery of Health Care

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Medicine(all)

Cite this

The costs of diabetic foot : The economic case for the limb salvage team. / Driver, Vickie R.; Fabbi, Matteo; Lavery, Lawrence A.; Gibbons, Gary.

In: Journal of Vascular Surgery, Vol. 52, No. 3 SUPPL., 09.2010.

Research output: Contribution to journalArticle

Driver, Vickie R. ; Fabbi, Matteo ; Lavery, Lawrence A. ; Gibbons, Gary. / The costs of diabetic foot : The economic case for the limb salvage team. In: Journal of Vascular Surgery. 2010 ; Vol. 52, No. 3 SUPPL.
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abstract = "Background: In 2007, the treatment of diabetes and its complications in the United States generated at least $116 billion in direct costs; at least 33{\%} of these costs were linked to the treatment of foot ulcers. Although the team approach to diabetic foot problems is effective in preventing lower extremity amputations, the costs associated with implementing a diabetic foot care team are not well understood. An analysis of these costs provides the basis for this report. Results: Diabetic foot problems impose a major economic burden, and costs increase disproportionately to the severity of the condition. Compared with diabetic patients without foot ulcers, the cost of care for patients with a foot ulcer is 5.4 times higher in the year after the first ulcer episode and 2.8 times higher in the second year. Costs for the treatment of the highest-grade ulcers are 8 times higher than for treating low-grade ulcers. Patients with diabetic foot ulcers require more frequent emergency department visits, are more commonly admitted to hospital, and require longer length of stays. Implementation of the team approach to manage diabetic foot ulcers within a given region or health care system has been reported to reduce long-term amputation rates from 82{\%} to 62{\%}. Limb salvage efforts may include aggressive therapy, such as revascularization procedures and advanced wound healing modalities. Although these procedures are costly, the team approach gradually leads to improved screening and prevention programs and earlier interventions, and thus seems to reduce long-term costs. Conclusions: To date, aggressive limb preservation management for patients with diabetic foot ulcers has not usually been paired with adequate reimbursement. It is essential to direct efforts in patient-caregiver education to allow early recognition and management of all diabetic foot problems and to build integrated pathways of care that facilitate timely access to limb salvage procedures. Increasing evidence suggests that the costs for implementing diabetic foot teams can be offset over the long-term by improved access to care and reductions in foot complications and in amputation rates.",
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