The costs of diabetic foot: The economic case for the limb salvage team
The costs of diabetic foot: The economic case for the limb salvage team
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DOI：
10.1016/j.jvs.2010.06.003
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发表时间：
2010-09-01
影响因子：
4.3
通讯作者：
Gibbons, Gary
中科院分区：
文献类型：
--
作者：
Driver, Vickie R.;Fabbi, Matteo;Gibbons, Gary
背景资料：2007年，美国糖尿病及其并发症的治疗至少产生了1160亿美元的直接成本;其中至少33%的成本与足部溃疡的治疗有关。虽然糖尿病足问题的团队方法在预防下肢截肢方面是有效的，但与实施糖尿病足护理团队相关的成本并不清楚。这些成本的分析提供了基础，本report.Results：糖尿病足问题造成了重大的经济负担，成本增加不成比例的严重程度的条件。与没有足部溃疡的糖尿病患者相比，足部溃疡患者的护理成本在第一次溃疡发作后的一年中高出5.4倍，第二年高出2.8倍。治疗最高级别溃疡的费用是治疗低级溃疡的8倍。糖尿病足溃疡患者需要更频繁的急诊就诊，更常入院，并需要更长的住院时间。据报道，在特定地区或医疗保健系统内实施团队方法来管理糖尿病足溃疡，可将长期截肢率从82%降至62%。保肢措施可能包括积极的治疗，如血运重建术和先进的伤口愈合方式。虽然这些程序是昂贵的，团队的方法逐渐导致改进的筛查和预防计划和早期干预，从而似乎减少长期costs.Conclusions：迄今为止，积极的肢体保护管理糖尿病足溃疡患者通常没有配对足够的报销。至关重要的是直接努力在病人护理人员的教育，使早期识别和管理所有糖尿病足问题，并建立综合的护理途径，促进及时获得保肢手术。越来越多的证据表明，实施糖尿病足团队的成本可以通过改善护理和减少足部并发症和截肢率来抵消。（J Vase Surg 2010;52：17S-22S.）
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. (J Vase Surg 2010;52:17S-22S.)