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Table 2 Major assumptions in cost-of-illness estimation

From: The cost of illness attributable to diabetic foot and cost-effectiveness of secondary prevention in Peru

A. Wound management without hospitalization
Outpatient: 1 first visit, 2 visits of control, 3 minor healing procedures in a hospital. Test: HbA1C, lipid profile, X-ray. Medication: Clindamycin 300 mg qid for 2 weeks.
B. Debridement
Inpatient: Emergency consultation, 6 days of hospitalization, evaluation by anesthesiologist and cardiologist, anesthesiology medication and surgical materials, debridement procedure, intermediate care unit and 6 wound healing procedures. Test: Pre-surgery tests, antibiogram, HbA1C, lipid profile and X-ray. Medication: Intravenous antibiotic (Ampicillin/Sulbactam 1.5 g qid for 3 days), oral antibiotics for 11 days and peripheral line. Outpatient: Consultations with physician until healed at the hospital and materials for dressing changes.
C. Amputation
Inpatient: Emergency consultation, 10 days (minor amputation) or 19 days (major amputation) of hospitalization, evaluation by anesthesiologist and cardiologist, anesthesiology medication and surgical materials, amputation procedure, intermediate care unit and blood transfusion. Test: Pre-surgery tests, bacteriology study, HbA1C, lipid profile, white cells count, X-ray, Doppler echography, arteriography, MRI, tissue biopsy. Medication: Intravenous antibiotic (Ampicillin/Sulbactam 1.5 g qid for 3 days in minor amputation and 5 days in major amputation), oral antibiotics (11 days in minor and 16 days in major amputation) and peripheral line. Outpatient: Consultations with physician and podiatrist until healed, materials for dressing changes (assuming that a nurse or a trained person at home is in charge of this procedure). Others: Rehabilitation sessions (40 for minor amputation and 50 for major amputation), orthopedic supplies for foot amputation (crutches and orthopedic foot) or for leg amputation (crutches, orthopedic leg, wheelchair), caregiver at home (conservative assumption of 6 months at Peru´s basic salary or 12 months working partial time).
D. Premature death
We assumed that 2 years (retirement age of 65) of paid productive work were lost due to the death and discounted at an annual rate of 3 %. Minimum wage rate in Peru amounts to PEN 750 in year 2012 (equivalent to US$284). We assumed a monthly income equal to minimum wage. The estimated indirect cost was US$6,719, which is the net value of the lost earnings for the next 2 years.
E. Sub-optimal care
Outpatient: 1 annual consultation with physician and podiatrist. Test: 1 annual testing of HbA1C, lipid profile, creatinine, electrocardiogram, X-ray.
F. Standard care
Outpatient: 6 consultations with physicians, 1 consultation with the podiatrist and 1 education session with a nurse. Test: 3 annual evaluations of HbA1C, 1 annual testing of lipid profile, 2 creatinine tests, 2 electrodiagrams and 1 X-ray. Others: protective footwear (a pair).
G. Standard care plus temperature monitoring
Similar to standard care, but in addition: thermometer and daily phone calls assisted by a nurse or a trained person (about 5 minutes per patient everyday).
  1. HbA1C glycosylated hemoglobin, MRI magnetic resonance imaging