The comparison of cost and cost-effectiveness in the treatment of a diabetic foot between primary and secondary care settings

Abstract

Aim: To investigate whether there is a difference in the cost and cost-effectiveness for treating and screening low to medium risk diabetic foot between Primary and Secondary Care setting.

Methods: A mixed method approach incorporating both the quantitative and qualitative methods was employed on a total of 100 participants recruited from the Primary and Secondary Care Podiatry Clinics. All participants went through a diabetic foot risk assessment at the beginning of the study to identify their risk status (low or medium risk). Participants were followed for a period of one year, whereby the number of podiatry assessments and treatments sessions attended during a year were recorded. Any podiatric tools and medical consumables used during each visit was recorded, together with the duration of assessment (minutes) for each visit. These were recorded in order to calculate and compare the mean cost of a podiatric assessment and treatment between the two health care settings. The cost-effectiveness of the podiatric assessment and treatment of the two settings was analysed by identifying whether the foot risk status of the participants remained the same or deteriorated after a one year follow-up. Changes in the foot health status and general health status were also recorded after one year.

Results: A significant difference in the cost outcome (including overhead costs) was obtained between the Primary and Secondary Care (p=0.007), with the Primary Care having the greater mean cost (€ 17.11) per podiatry session. Significant differences were also recorded in the number of screening assessment per year (0.001), number of podiatry sessions (0.000), and mean assessment time (0.000) between the two settings. No significant changes were recorded in the risk status of participants attending both settings (p=0.646)

Conclusion: Podiatric assessment and treatment of low to medium risk individuals is more costly in a Primary Care setting than in the Secondary Care. This is possibly related to an increased number of assessments and treatment that individuals attend in a Primary Care compared to Secondary Care. Having a more elderly population attending Primary Care, it is probably the reason why individuals seek more often podiatry visits than the population that attends Secondary Care. Since no significant changes were recorded in the risk status of participants attending both settings after a year, it has been concluded that the clinical setting being treated did not correlate with the risk status of participants. Due to this, the Podiatric service offered within the Primary Care setting is not found to be cost-effective.