Driver Vickie R, Fabbi Matteo, Lavery Lawrence A, Gibbons Gary
Department of Surgery, Boston Medical Center and Boston University School of Medicine, Boston, MA 02118, USA.
J Am Podiatr Med Assoc. 2010 Sep-Oct;100(5):335-41. doi: 10.7547/1000335.
In 2007, the treatment of diabetes and its complications in the United States generated at least $116 billion in direct costs; at least 33% of these costs were linked to the treatment of foot ulcers. Although the team approach to diabetic foot problems is effective in preventing lower-extremity amputations, the costs associated with implementing a diabetic-foot-care team are not well understood. An analysis of these costs provides the basis for this report. Diabetic foot problems impose a major economic burden, and costs increase disproportionately to the severity of the condition. Compared with diabetic patients without foot ulcers, the cost of care for those with foot ulcers is 5.4 times higher in the year after the first ulcer episode and 2.8 times higher in the second year. Costs for treating the highest-grade ulcers are 8 times higher than are those for treating low-grade ulcers. Patients with diabetic foot ulcers require more frequent emergency department visits and are more commonly admitted to the hospital, requiring longer lengths of stay. Implementation of the team approach to manage diabetic foot ulcers in a given region or health-care system has been reported to reduce long-term amputation rates 62% to 82%. Limb salvage efforts may include aggressive therapy such as revascularization procedures and advanced wound-healing modalities. Although these procedures are costly, the team approach gradually leads to improved screening and prevention programs and earlier interventions and, thus, seems to reduce long-term costs. To date, aggressive limb preservation management for patients with diabetic foot ulcers has not usually been paired with adequate reimbursement. It is essential to direct efforts in patient-caregiver education to allow early recognition and management of all diabetic foot problems and to build integrated pathways of care that facilitate timely access to limb salvage procedures. Increasing evidence suggests that the costs of implementing diabetic foot teams can be offset in the long term by improved access to care and reductions in foot complications and amputation rates.
2007年，美国糖尿病及其并发症的治疗产生了至少1160亿美元的直接成本；其中至少33%的成本与足部溃疡的治疗有关。尽管团队协作处理糖尿病足部问题在预防下肢截肢方面是有效的，但实施糖尿病足部护理团队的相关成本却并未得到充分了解。对这些成本的分析为本报告提供了依据。糖尿病足部问题带来了巨大的经济负担，且成本随着病情严重程度的增加而不成比例地上升。与没有足部溃疡的糖尿病患者相比，足部溃疡患者在首次溃疡发作后的一年里护理成本高出5.4倍，在第二年高出2.8倍。治疗最高等级溃疡的成本比治疗低等级溃疡的成本高出8倍。糖尿病足部溃疡患者需要更频繁地前往急诊科就诊，且更常住院，住院时间也更长。据报道，在特定地区或医疗保健系统中采用团队协作方法管理糖尿病足部溃疡可将长期截肢率降低62%至82%。肢体挽救措施可能包括积极的治疗，如血管重建手术和先进的伤口愈合方式。尽管这些手术成本高昂，但团队协作方法会逐渐带来更好的筛查和预防项目以及更早的干预措施，因此似乎能降低长期成本。迄今为止，针对糖尿病足部溃疡患者的积极肢体保全管理通常并未与足够的报销费用相匹配。必须致力于对患者及其护理人员进行教育，以便早期识别和处理所有糖尿病足部问题，并建立综合护理途径，以促进及时获得肢体挽救手术。越来越多的证据表明，实施糖尿病足部护理团队的成本从长远来看可以通过改善医疗服务可及性以及降低足部并发症和截肢率来抵消。
