[Calculation of the costs of drugs, medical materials, certain medical procedures and social services for patients with diabetic foot syndrome].

The aim of this study was to analyse the direct costs of some components of primary, secondary and tertiary prevention of the diabetic foot syndrome (cost of illness study). Information considering the costs of prevention and therapy of the diabetic foot and costs following after amputation in diabetic patients is available from international economical trials but is almost missing in the Czech Republic. The economical assessment of the most important mean of primary prevention/which is regular dispensarisation and preventive care for diabetic patients in risk of diabetic foot syndrome/is very problematic. The costs of primary prevention were calculated as the intervention costs of risk factors of diabetic foot syndrome according to the recommended daily doses and prices of the medicaments in AISLP database. Costs of hospitalisation in secondary and tertiary prevention were calculated by using bills for health insurance company in the programme Steiner-UNIS, costs for out-patient care according to ordinations (medication, aids, codes for heath insurance companies and means of diagnostic process). Costs of tertiary prevention were based on information gained from the Regional Social Authority. There were 20 patients (12 men, 8 women, age 65 +/- 12 years, 3 patients with 1. type diabetes, 17 with 2. type diabetes), involved in secondary in-patient care, 30 (20 men, 10 women, age 69 +/- 12.4 years, 2 patients with type 1. diabetes, 28 with type 2 diabetes) in out-patient care and 20 (12 men, 8 women, age 70 +/- 9.4 years, 1 patient with type 1 diabetes, 19 with type 2 diabetes) in tertiary prevention. This study proved high costs of the intervention of hyperglycaemia in type 1. diabetics, hypertension with ACE inhibitors, critical ischaemia, neuropathy. Costs of out-patient care for ulcers for eight months were 7,500.- +/- 4,400.-CK, antimicrobial treatment 1,900.-CK, in-patient care for ulcers 22,500.- +/- 6,400.-CK and amputation 22,000.- +/- 9,900.-CK. The highest costs were calculated for tertiary prevention--the first year after amputation 400,000.- CK. The study shows very high costs of tertiary prevention and suggests discussion on this topic.