2.5. Outpatient DFD Costs

We used a micro-costing approach based on health resource utilization. A panel of 12 experts in DFD from various reference centers in the country, provided information on healthcare resources utilization for outpatient management of each case. When considering the range of syndromes that were included in the DFD spectrum, costs for the following four well-defined hypothetical DFD cases, occurring in one or two lower extremities, and managed as outpatients were estimated: (1) neuroischemic foot without ulcer, (2) non-infected foot ulcer, (3) infected foot ulcer, and (4) clinical management of amputated patients.

Based on the National Guidelines for DFD management [23,24], we developed a standardized questionnaire in which resource utilization for the following healthcare components were assessed: imaging and laboratory exams; medications; procedures and non-pharmacological therapies (debridement and dressings, in addition to important supplies, such as orthopedic shoes and crutch); and, health professional visits. The questionnaire was piloted and revised based on feedback received from the pilot. Since the centers could have different healthcare access to this specialized treatment, for each healthcare component, a list of treatments included in the guidelines was provided. For the same reason, resources not listed could be added by the expert. In cases where the quantity was not specified, one item per episode was considered. Costs of imaging and laboratory exams; non-pharmacological therapies; and health professional visits were obtained from National Standardized SUS Pricing List [25]. The costs of medications were estimated based on the average price of medication purchased by government [26]. Healthcare resources unit cost were multiplied by quantity, resulting in an estimated average cost for each outpatient hypothetical case.