Abstract
BackgroundDiabetic foot ulcer (DFU) is a severe complication of diabetes and particularly susceptible to infection. DFU infection intervention efficacy is declining due to antimicrobial resistance and a systematic review of economic evaluations considering their economic feasibility is timely and required.AimTo obtain and critically appraise all available full economic evaluations jointly considering costs and outcomes of infected DFUs.MethodsA literature search was conducted across MedLine, CINAHL, Scopus and Cochrane Database seeking evaluations published from inception to 2019 using specific key concepts. Eligibility criteria were defined to guide study selection. Articles were identified by screening of titles and abstracts, followed by a full-text review before inclusion. We identified 352 papers that report economic analysis of the costs and outcomes of interventions aimed at diabetic foot ulcer infections. Key characteristics of eligible economic evaluations were extracted, and their quality assessed against the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.Results542 records were screened and 39 full-texts assessed for eligibility. A total of 19 papers were included in the final analysis. All studies except one identified cost-saving or cost-effective interventions. The evaluations included in the final analysis were so heterogeneous that comparison of them was not possible. All studies were of “excellent”, “very good” or “good” quality when assessed against the CHEERS checklist.ConclusionsConsistent identification of cost-effective and cost-saving interventions may help to reduce the DFU healthcare burden. Future research should involve clinical implementation of interventions with parallel economic evaluation rather than model-based evaluations.
Highlights
We identified 352 papers that report economic analysis of the costs and outcomes of interventions aimed at diabetic foot ulcer infections
[5] A significant consequence for those Diabetic foot ulcer (DFU) which do not heal is infection which has an incidence of 40.1%. [6] DFU infection is a well-recognised risk-factor for lower extremity amputation which occurs in 8% [5] of cases and carries a 5-year mortality of 74%. [7]
Cost-effective DFU interventions have been identified in previous systematic reviews of economic evaluations, [10,11,12,13] these reviews do not focus on those evaluations where infection is part of the clinical presentation of the DFU or model pathway
Summary
Diabetic foot ulcers (DFU) are a common and severe complication of diabetes mellitus characterised by a deep tissue lesion. [1] Factors underlying the development of DFU are peripheral sensory neuropathy, foot deformity, minor foot trauma and peripheral arterial disease. [2] It is estimated that the annual incidence of DFU is 2–4% [3, 4] in developed countries with only two-thirds of cases healing within 12 months. [5] A significant consequence for those DFUs which do not heal is infection which has an incidence of 40.1%. [6] DFU infection is a well-recognised risk-factor for lower extremity amputation which occurs in 8% [5] of cases and carries a 5-year mortality of 74%. [7] is DFU a source of significant patient suffering, it brings significant costs to the individual and healthcare system. Diabetic foot ulcers (DFU) are a common and severe complication of diabetes mellitus characterised by a deep tissue lesion. [2] It is estimated that the annual incidence of DFU is 2–4% [3, 4] in developed countries with only two-thirds of cases healing within 12 months. The cost burden of DFU requires 6 days to 5.7 years of patient income to cover treatment cost with variation based on setting and treatment strategy. [8] The annual cost of DFU treatment is significantly greater than non-diabetic foot ulcer treatment, estimated at $1.38 billion versus $0.13 billion. Diabetic foot ulcer (DFU) is a severe complication of diabetes and susceptible to infection. DFU infection intervention efficacy is declining due to antimicrobial resistance and a systematic review of economic evaluations considering their economic feasibility is timely and required
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