Costs of deep foot infections in patients with diabetes mellitus

Objective: To calculate costs for the management of deep foot infections and to identify the most important factors related to treatment costs. Design: Costs for in-hospital care, surgery, investigations, antibacterials, visits to the foot-care team, orthopaedic appliances and topical treatment were calculated retrospectively from diagnosis until healing or death. Multiple regression analysis was used to identify factors that independently affect costs. Setting: A multidisciplinary foot-care team. Patients: 220 prospectively followed patients with diabetes mellitus and deep foot infections who were referred to the team from 1986 to 1995. Main Outcome Measures and Results: Total cost for healing without amputation was Swedish kronor (SEK)136 600 per patient, while the corresponding cost for healing with minor amputation was SEK260 000 and with major amputation was SEK234 500. All costs were quoted in SEK at 1997 price levels (pound 1 sterling and $US1 equalled approximately SEK12.50 and SEK7.64, respectively). The cost of antibacterials was 4% of total costs. The cost of topical treatment was 51% of total costs and related to wound healing time. Number of weeks between diagnosis of deep foot infection and healing, and number of surgical procedures were variables that explained 95% of costs in the multiple regression analysis. It was not possible to find any parameters present at diagnosis that could contribute to an explanation of total treatment costs. Conclusions: Topical treatment accounted for the largest proportion of total costs and the most important cost driving factors were wound healing duration and repeated surgery. Costs of antibacterials should not be used as an argument in the choice between early amputation and conservative treatment.