Cost of illness among patients with diabetic foot ulcer in Turkey

Table 1 The average unit cost of outpatient to which the admissions are made in the treatment of diabetic foot ulcer

	Average unit cost ($-PPP 2014)
Outpatient clinics
Endocrinology and metabolic diseases	27.1
Orthopedics and traumatology	25.4
Plastic and reconstructive surgery	26.8
Dermatology	22.4
Infectious diseases	27.3
Neurology	27.5
Nephrology	27.4
Cardiovascular surgery	27.8
Physical therapy and rehabilitation	26.4
Algology	31.0
Medical ecology and hydroclimatology	25.6
Consultations
Infectious diseases - consultation	5.2
Orthopedics and traumatology - consultation
Cardiovascular surgery - consultation
Plastic and reconstructive surgery - consultation
Dermatology - consultation

Table 2 Unit costs of imaging - laboratory tests used in the treatment of diabetic foot ulcer

Name of test	Average unit cost ($-PPP 2014)
Imaging tests
Direct foot X-ray	Included in outpatient clinic admission fee
Electrocardiogram
Unilateral chest X-ray
Doppler ultrasonography	32.4
Magnetic resonance angiography	55.1
Angiography	392.3
Scintigraphy	131.7
Laboratory tests
Bone biopsy	97.6
Tissue culture	97.6
Aspiration/swab culture	33.8
Bone curettage culture	97.6
HbA1c	3.4
Bleeding profile (Pre-op)	12.2
Glucose	Included in outpatient clinic admission fee
Hemogram
C-reactive protein
Red blood cell sedimentation rate
Albumin
Kidney function tests
Liver function tests
Hepatitis markers

HbA1c: Hemoglobin A1c.

Table 3 Hospitalizations in departments for treatment of diabetic foot ulcer

Admission to department	Rate of patients (%)	Hospitalization period
Wound follow-up	44.9	23
Amputation surgery	53.9	42
Revascularization surgery	12.0	5
Plastic and reconstructive surgery - graft/flap	24.0	12

Table 4 Medical and surgical interventions performed in the treatment of diabetic foot ulcer and their costs

Interventions	Rate of patients (%)	Average cost ($-PPP 2014)
Osteomyelitis treatment	66.0	605.0
Wound debridement	10.1	813.7
Graft/flap	24.0	602.1
Percutaneous transluminal angioplasty	6.0	6250.9
Bypass	6.0	6512.4
Amputation	53.9	961.7
Hyperbaric oxygen treatment	8.0	70.01
Physical therapy and rehabilitation	16.6	31.31
Diabetic foot patient training	100.0	1.5

¹Cost per session.

Table 5 Distributions of annual drug use of patients regarding drugs and other medical materials

Drugs and medical materials	Average cost ($-PPP 2014)
Insulin	1118.9
Antibiotics - in the group of wounds with low risk	78.1
Antibiotics - in the group of wounds with moderate risk	240.0
Antibiotics - in the group of wounds with serious risk	764.5
Anti-thrombotic	1348.4
Orthosis and prosthesis devices	961.5
Wound sheath	101.8

Table 6 The average annual cost per patient in diabetic foot treatment ($-PPP 2014)

Cost components	Average per patient annual cost ($-PPP)
Outpatient costs	579.5
Laboratory costs	284.8
Imaging test costs	283.2
Inpatient costs	7357.4
Intervention costs	2291.7
Drug costs	2545.8
Medical material costs	735.0
Complication costs	210.3
Total cost per patient	14287.7

Table 7 Result of sensitivity analysis for the total costs of diabetic foot ulcer

Cost components	$-PPP (n = 5000)
	Average	SD	95%CI	Median
Outpatient costs	576.2	196.1	568.0-584.4	565.5
Cost of imaging tests	279.4	205.6	267.9-291.0	219.2
Laboratory costs	283.3	64.7	278.7-287.7	254.8
Inpatient costs	7290.3	5047.9	6864.8-7715.8	8969.5
Intervention costs	2212.3	2347.7	1980.3-2444.4	1568.2
Drug costs	2554.4	566.3	2490.7-2618.2	2707.4
Cost of medical supplies	742.0	538.0	673.9-810.2	961.5
Cost of complications	208.7	452.7	145.0-272.5	0.0
Total cost	14146.8	5706.6	13988.6-14304.9	14615.4