Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes

widely used in Australia, only the data comparing SC and WCC are considered here.The total costs for 20 weeks were $A 2446 for SC and $A 2330 for WCC. The ratesof ulcers healed were 30.9% (95% CI 26.6-35.0%) for SC and 35.6% (CI 34.8-36.4%)for WCC. Although cost were similar outcomes were better for the WCC. Howeverthis study is limited by the database used and the probably that people attendingwound care clinics had more severe lesions than people receiving standard care.Horswell et al (2003) compared a staged diabetes foot management programme withstandard care on health care cost and utilisation in a retrospective study. All subjectshad diabetes and foot ulcers, of whom 45 received staged foot care that consisted ofselfcare education, devices to offload pressure, and custom-fabricated orthoses andfootwear after healing, while 169 subjects received standard foot care which consistedof uncoordinated treatment including wound care, antibiotics and self care education.Baseline characteristics were similar in both groups. In the 1-year follow-up period,the staged foot care group had a lower foot-related hospitalisation rate than thestandard care group (0.09 v 0.50 admissions per person, p=0.002), lower foot-relatedinpatient days (0.91 v 3.97 days per person, p=0.03), and fewer amputation-relatedhospitalisation (0.04 v 0.19 per person, p=0.035). There were also fewer emergencyvisits (0.60 v 1.22 visits, p=0.004) and lower emergency department charges ($104 v$208, p=0.006) in the staged foot care group compared with the standard care group.Overall the total cost was significantly lower in the staged foot care group than in thestandard care group ($A 6,630 v $A 13,060, p=0.014).Ortegon et al (2004) performed a cost-effectiveness analysis of prevention andtreatment of diabetes foot disease in the Netherlands. A Markov model was developedto simulate the health and economic outcomes of optimal care of the diabetic foot in acohort of 10,000 people (mean age 61 years) with newly diagnosed Type 2 diabeteswho were followed through the model over their lifetime. Diabetic foot risk (DFR),based on the classification system of the International Diabetic Foot Working Group,was defined as: DFR1 - no neuropathy; DFR2 - sensory neuropathy, and DFR3 -sensory neuropathy and deformity or PVD. Costs used in the model were expressed as1999 dollars. Compared with current standard care, the mean total lifetime costs of aperson receiving guideline-based care (intensive glycaemic control (IGC) or optimalfoot care (OFC)) ranged from $A 5,680 to $A 6,090. For people receiving IGC andOFC, the costs resulted in