Objectives: To evaluate the outcomes and current costs of 4 different scenarios of diabetic foot ulcers (DFU) treatment in Russian current medical practice. Method(s): We developed a decision tree model estimating annual number of outcomes (major and minor amputations) and costs for 4 simplified possible scenarios of medical care: 1) outpatient diabetic foot clinic, 2) non-specialized outpatient care, 3) cessation of the outpatient treatment by patient after the second visit and 4) care provided only at hospital (without previous visits to any outpatient clinic). The distribution of the patient cohort (1000 patients) among the scenarios and rates of possible events were based on published Russian data and experts' survey. Costs were calculated from the overall governmental budget point of view and included inpatient and outpatient care for DFU treatment, total contact casting, medications and dressings provided in the outpatient care, prosthetic devices and services. Cost data was derived from published retrospective study comparing provision of care to DFU patients in specialized and non-specialized clinics in Russia and reimbursement rates in public medical insurance and social care. Result(s): The lowest rate of amputations per patient (0.07 for minor and 0.01 for major) is expected for those receiving treatment in the outpatient diabetic foot clinic with mean annual cost 279.68 per patient. The highest costs ( 1141.17) and amputation rates (0.29 for minor and 0.19 for major) per patient are observed in the group treated at hospital only. The minor amputation rate and annual costs are higher for patients following non-specialized outpatient care than for those ceasing the outpatient treatment - 0.11 vs 0.09 and 449.82 vs 381.30, and the reverse was observed for the rate of major amputations - 0.03 vs 0.06. Conclusion(s): Referring DFU patients to the outpatient diabetic foot clinics as early as possible appears to be the most cost-effective way of treating them.
Ignatyeva, V., Avxentyeva, M., Galstyan, G. R., Bregovskiy, V., & Udovichenko, O. (2014). Direct Costs of Diabetic Foot Ulcers in Russia. Value in Health, 17(7), A342. https://doi.org/10.1016/j.jval.2014.08.682