Diabetic foot ulcer management in clinical practice in the UK: costs and outcomes

Abstract

The aim of this study was to estimate the patterns of care and annual levels of health care resource use attributable to managing diabetic foot ulcers (DFUs) in clinical practice by the UK's National Health Service (NHS), and the associated costs of patient management. This was a retrospective cohort analysis of the records of 130 patients with a newly diagnosed DFU in The Health Improvement Network (THIN) database. Patients' characteristics, wound-related health outcomes and health care resource use were quantified, and the total NHS cost of patient management was estimated at 2015-2016 prices. Patients were predominantly managed in the community by nurses, with minimal clinical involvement of specialist physicians. 5% of patients saw a podiatrist, and 5% received a pressure-offloading device. Additionally, 17% of patients had at least one amputation within the first 12 months from initial presentation of their DFU. 14% of DFUs were documented as being clinically infected at initial presentation, although an additional 31% of patients were prescribed an antimicrobial dressing at the time of presentation. Of all the DFUs, 35% healed within 12 months, and the mean time to healing was 4·4 months. Over the study period, 48% of all patients received at least one prescription for a compression system, but significantly more patients healed if they never received compression (67% versus 16%; P < 0·001). The mean NHS cost of wound care over 12 months was an estimated £7800 per DFU (of which 13% was attributable to amputations), ranging from £2140 to £8800 per healed and unhealed DFU, respectively, and £16 900 per amputated wound. Consolidated medical records from a primary care held database provided 'real-world evidence' highlighting the consequences of inefficient and inadequate management of DFUs in clinical practice in the UK. Clinical and economic benefits to both patients and the NHS could accrue from strategies that focus on (i) wound prevention, (ii) improving wound-healing rates and (iii) reducing infection and amputation rates.

Keywords: Burden; Cost; Diabetic foot ulcers; UK; Wounds.

Figure 1

Wound healing.

Figure 2

Kaplan–Meier time to healing analysis for patients who did and did not receive compression. The healing distribution between the two groups was significantly different (Log Rank (Mantel‐Cox): P < 0·0001).

Figure 3

Kaplan–Meier time to healing analysis for patients who did and did not receive prescribed analgesics and neuroleptics. The healing distribution between the two groups was significantly different (Log Rank (Mantel‐Cox): P = 0·002).

Figure 4

Kaplan–Meier time to healing analysis for patients who did and did not receive prescribed anti‐infectives. The healing distribution between the two groups was significantly different (Log Rank (Mantel‐Cox): P = 0·002).

Figure 5

Monthly NHS cost of wound care at 2015–2016 prices.