Direct costs and outcomes for inpatients with diabetes mellitus and foot ulcers in a developing country: The experience of the public health system of Brazil

Abstract

Aims Analyze the care received by hospitalized patients with diabetes mellitus and foot ulcers in Brazil, taking into account clinical and economic aspects. Methods A cohort prospective study of 109 patients with diabetes hospitalized primarily for foot ulcers covered exclusively by the Brazilian public health system. All patients had type 2 diabetes mellitus, the staff at the hospitals has no specific training in the care of diabetic foot and study patients did not have access to multidisciplinary teams or rehabilitation facilities, characterizing a non-organized set. Results Patients had chronic infected deep ulcers with little or no prior access to a specialized foot clinic before the hospitalization. Forty-three (39%) patients were discharged with primary healing and 52 (48%) were healed with amputation. Fourteen (13%) patients died during hospitalization. Only five (4.6%) patients received reconstructive vascular procedures. Direct cost per patient varied between US$ 324.3 and US$ 5628.4 (1533.0 ± 1029.3). The total cost for the 109 hospitalizations was US$ 167,097.4. Conclusions In this non-organized set, inpatient care for diabetic foot in the public health system of Brazil is related to high costs and bad outcomes.