Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Oct 15, 2016; 7(18): 462-469
Published online Oct 15, 2016. doi: 10.4239/wjd.v7.i18.462
Cost of illness among patients with diabetic foot ulcer in Turkey
Ergun Oksuz, Simten Malhan, Bilge Sonmez, Rukiye Numanoglu Tekin
Ergun Oksuz, Department of Family Medicine, Faculty of Medicine, Baskent University, 06770 Ankara, Turkey
Simten Malhan, Faculty of Health Sciences, Baskent University, 06770 Ankara, Turkey
Bilge Sonmez, Emir Karatekin Family Health Center, Cankiri Karatekin University, 18100 Cankiri, Turkey
Rukiye Numanoglu Tekin, Faculty of Health Sciences, Baskent University, 6770 Ankara, Turkey
Author contributions: Oksuz E contributed to study conception and design, data acquisition, data analysis and interpretation, writing of article, editing, reviewing and final approval of the article; Malhan S, Sonmez B and Numanoglu Tekin R contributed to study conception and design, data acquisition, data analysis and interpretation, and writing of the article.
Institutional review board statement: Not required.
Informed consent statement: Not required.
Conflict-of-interest statement: We have no conflict of interest to declare.
Data sharing statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Ergun Oksuz, MD, Professor, Department of Family Medicine, Faculty of Medicine, Baskent University, Baglica Campus, 06770 Ankara, Turkey. eoksuz@baskent.edu.tr
Telephone: +90-312-2466773 Fax: +90-312-2466770
Received: June 17, 2016
Peer-review started: June 23, 2016
First decision: July 4, 2016
Revised: August 5, 2016
Accepted: August 27, 2016
Article in press: August 29, 2016
Published online: October 15, 2016
Processing time: 115 Days and 20.1 Hours
Abstract
AIM

To evaluate the annual cost of patients with Wagner grade 3-4-5 diabetic foot ulcer (DFU) from the public payer’s perspective in Turkey.

METHODS

This study was conducted focused on a time frame of one year from the public payer’s perspective. Cost-of-illness (COI) methodology, which was developed by the World Health Organization, was used in the generation of cost data. By following a clinical path with the COI method, the main total expenses were reached by multiplying the number of uses of each expense item, the percentage of cases that used them and unit costs. Clinical guidelines and real data specific to Turkey were used in the calculation of the direct costs. Monte Carlo Simulation was used in the study as a sensitivity analysis.

RESULTS

The following were calculated in DFU treatment from the public payer’s perspective: The annual average per patient outpatient costs $579.5 (4.1%), imaging test costs $283.2 (2.0%), laboratory test costs $284.8 (2.0%), annual average per patient cost of intervention, rehabilitation and trainings $2291.7 (16.0%), annual average per patient cost of drugs used $2545.8 (17.8%) and annual average per patient cost of medical materials used in DFU treatment $735.0 (5.1%). The average annual per patient cost for hospital admission is $7357.4 (51.5%). The average per patient complication cost for DFU is $210.3 (1.5%). The average annual per patient cost of DFU treatment in Turkey is $14287.70. As a result of the sensitivity analysis, the standard deviation of the analysis was $5706.60 (n = 5000, mean = $14146.8, 95%CI: $13988.6-$14304.9).

CONCLUSION

The health expenses per person are $-PPP 1045 in 2014 in Turkey and the average annual per patient cost for DFU is 14-fold of said amount. The total health expense in 2014 in Turkey is $-PPP 80.3 billion and the total DFU cost has a 3% share in the total annual health expenses for Turkey. Hospital costs are the highest component in DFU disease costs. In order to prevent DFU, training of the patients at risk and raising consciousness in patients with diabetes mellitus (DM) will provide benefits in terms of economy. Appropriate and efficient treatment of DM is a health intervention that can prevent complications.

Keywords: Diabetic foot; Diabetes complications; Cost of illness; Burden of illness; Amputation

Core tip: The purpose of this study is to evaluate the annual cost of patients with Wagner grade 3-4-5 diabetic foot ulcer (DFU) in Turkey. Cost-of-illness methodology was used in the generation of cost data. Monte Carlo Simulation was used in the study as a sensitivity analysis. The average annual per patient cost of DFU treatment in Turkey is $14287.70. As a result of the sensitivity analysis, the standard deviation of the analysis was $5706.60 (n = 5000, mean = $14146.8, 95%CI: $13988.6-$14304.9). Hospital costs are the highest component in DFU disease costs.