***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Aims /hypothesisThe aim of the present study was to investigate re source utilisation and associated costs in patients with diabetic foot ulcers and to analyse differences in re source utilisation between individuals with or without peripheral arterial disease ( PAD ) and /or infection . Methods Data on re source utilisation were collected prospect ively in a European multicentre study . Data on 1,088 patients were available for the analysis of re source use , and data on 821 patients were included in the costing analysis . Costs were calculated for each patient by multiplying the country-specific direct and indirect unit costs by the number of re sources used from inclusion into the study up to a defined endpoint . Country-specific costs were converted into purchasing power st and ards . Results Re source use and costs varied between outcome groups and between disease severity groups . The highest costs per patient were for hospitalisation , antibiotics , amputations and other surgery . All types of re source utilisation and costs increased with the severity of disease . The total cost per patient was more than four times higher for patients with infection and PAD at inclusion than for patients in the least severe group , who had neither . Conclusions /interpretationImportant differences in re source use and costs were found between different patient groups . The costs are highest for individuals with both peripheral arterial disease and infection , and these are mainly related to substantial costs for hospitalisation . In view of the magnitude of the costs associated with in-hospital stay , reducing the number and duration of hospital admissions seems an attractive option to decrease costs in diabetic foot disease OBJECTIVE Determine the cost-effectiveness of extracellular matrix ( ECM ) relative to human fibroblast-derived dermal substitute ( HFDS ) on  diabetic foot ulcer ( DFU ) wound closure .  METHOD Outcomes data were obtained from a 12-week , r and omised , clinical trial of adults aged 18 years or older diagnosed with type 1 or type 2 diabetes with a DFU . Patients were treated with either ECM or HFDS treatment . A two-state Markov model ( healed and unhealed ) with a 1-week cycle length was developed using wound-closure rates from the trial to estimate the number of closed-wound weeks and the expected DFU cost per patient . Results were recorded over 12 weeks to estimate the number of closed-wound weeks per treatment and the average cost to achieve epithelialisation ( primary outcome ) . The perspective of the analysis was that of the payer , specifically the Centers for Medicare and Medicaid Services . No cost discounting was performed because of the short duration of the study . RESULTS The study consisted of 26 patients , with 13 in each group . In the ECM group , 10 wounds closed ( 77 % ) , with an average closure time of 36 days ; 11 wounds closed in the HFDS group ( 85 % ) , with an average closure time of 41 days . There was no significant difference between these results ( p=0.73 ) . Over 12 weeks , the expected cost per DFU was $ 2522 ( £ 1634 ) for ECM and $ 3889 ( £ 2524 ) for HFDS . Patients treated with HFDS  incurred total treatment costs that were approximately 54 % higher than those treated with ECM . Sensitivity analyses revealed that the total cost of care for two applications of HFDS was more costly than eight applications of ECM by approximately $ 500 ( £ 325 ) . CONCLUSION In patients with DFU  , ECM yielded similar clinical outcomes to HFDS but at a lower cost . Health-care providers should consider ECM as a cost-saving alternative to HFDS . DECLARATION OF INTEREST A.M. Gilligan , and C.R. Waycaster , are employees of Smith & Nephew Inc .. This study was funded by Smith & Nephew Inc .. A.L. L and sman , reports no conflicts of interest BACKGROUND Despite significant advances , the treatment of  diabetic foot ulcers ( DFUs ) remains a major therapeutic challenge for clinicians , surgeons , and other health care professionals . There is an urgent need for new strategies with clinical ly effective interventions to treat DFUs to reduce the burden of care in an efficient and cost-effective way . OBJECTIVE This r and omized trial evaluated and compared the clinical effectiveness , tolerability , and costs of clostridial collagenase ointment ( CCO ) debridement to that of debridement using saline moistened gauze ( SMG ) and selective sharp debridement for the treatment of DFUs . METHODS R and omized , controlled , parallel group , multicenter , open-label , 12-week study of 48 patients with neuropathic DFUs r and omized to 4 weeks of treatment with either CCO or SMG after baseline surgical debridement . The primary end point was the condition of the ulcer bed at the end of treatment as measured using a st and ardized wound assessment tool . Secondary end points were the percentage of reduction in wound area and therapeutic response rates . Adverse events were monitored for the tolerability analysis . In addition , a comparative cost-effectiveness analysis was performed from the perspective of the Centers for Medicare and Medicaid Services as a payer . RESULTS Both the CCO and SMG groups had significantly improved wound assessment scores after 4 weeks of treatment ( CCO , -2.5 , P = 0.007 ; SMG , -3.4 , P = 0.006 ) . Only CCO treatment result ed in a statistically significant decrease from baseline in the mean wound area at the end of treatment ( P = 0.0164 ) and at the end of follow-up ( P = 0.012 ) . In addition , the CCO group exhibited a significantly better response rate at the end of follow-up compared with the SMG group ( 0.92 vs 0.75 , P < 0.05 ) . Reported adverse events were similar between the 2 treatment groups . None of the reported adverse events were considered to be related to treatment . The economic analysis indicated that the direct mean costs per responder in the physician office setting of care were $ 832 versus $ 1042 for the CCO group versus the SMG group , whereas the direct mean costs per responder in the hospital outpatient department setting were $ 1607 versus $ 1980 . CONCLUSIONS CCO treatment provides equivalent debridement of DFUs similar to SMG while fostering better progress toward healing as measured by decreasing wound area over time and improved response rates at the end of follow-up . In addition , CCO yields a more favorable cost-effectiveness ratio in both the physician office and hospital outpatient department setting s of care . Clinical Trials.gov identifier : NCT01056198 OBJECTIVE To estimate the annual , per-patient incremental burden of diabetic foot ulcers ( DFUs ) . RESEARCH DESIGN AND METHODS DFU patients and non-DFU patients with diabetes ( controls ) were selected using two deidentified data bases : ages 65 + years from a 5 % r and om sample of Medicare beneficiaries ( St and ard Analytical Files , January 2007–December 2010 ) and ages 18–64 years from a privately insured population ( OptumInsight , January 2007–September 2011 ) .  Demographics , comorbidities , re source use , and costs from the payer perspective incurred during the 12 months prior to a DFU episode were identified . DFU patients were matched to controls with similar pre-DFU characteristics using a propensity score methodology . Per-patient incremental clinical outcomes ( e.g. , amputation and medical re source utilization ) and health care costs ( 2012 U.S. dollars ) during the 12-month follow-up period were measured among the matched cohorts . RESULTS Data for 27,878 matched pairs of Medicare and 4,536 matched pairs of privately insured patients were analyzed . During the 12-month follow-up period , DFU patients had more days hospitalized ( + 138.2 % Medicare , + 173.5 % private ) , days requiring home health care ( + 85.4 % Medicare , + 230.0 % private ) , emergency department visits ( + 40.6 % Medicare , + 109.0 % private ) , and outpatient/physician office visits ( + 35.1 % Medicare , + 42.5 % private ) than matched controls . Among matched patients , 3.8 % of Medicare and 5.0 % of privately insured DFU patients received lower limb amputations . Increased utilization result ed in DFU patients having $ 11,710 in incremental annual health care costs for Medicare , and $ 16,883 for private insurance , compared with matched controls . Privately insured matched DFU patients incurred excess work-loss costs of $ 3,259 . CONCLUSIONS These findings document that DFU imposes substantial burden on public and private payers , ranging from $ 9–13 billion in addition to the costs associated with diabetes itself OBJECTIVE ischaemic lower-extremity ulcers in the diabetic population are a source of major concern because of the associated high risk of limb-threatening complications . The aim of this study was to evaluate the role of hyperbaric oxygen in the management of these ulcers . METHOD eighteen diabetic patients with ischaemic , non-healing lower-extremity ulcers were recruited in a double-blind study . Patients were r and omly assigned either to receive 100 % oxygen ( treatment group ) or air ( control group ) , at 2.4 atmospheres of absolute pressure for 90 min daily ( total of 30 treatments ) . RESULTS healing with complete epithelialisation was achieved in five out of eight ulcers in the treatment group compared to one out of eight ulcers in the control group . The median decrease of the wound areas in the treatment group was 100 % and in the control group was 52 % ( p=0.027 ) . Cost-effectiveness analysis has shown that despite the extra cost involved in using hyperbaric oxygen , there was a potential saving in the total cost of treatment for each patient during the study . CONCLUSION hyperbaric oxygen enhanced the healing of ischaemic , non-healing diabetic leg ulcers and may be used as a valuable adjunct to conventional therapy when reconstructive surgery is not possible This prospect i ve observational study was carried out to assess the annual  preventive and curative treatment costs  for diabetic foot problems . Measures of re source use over the 1-year study period were taken for 151 patients whose lesions covered the entire Wagner classification .  Treatment was provided under the current protocol s of a multidisciplinary team . The 1993 market prices for health services were used to convert units of health service utilization to expenditures by the social insurance system and the patients . The severity of the foot problems determined the medical cost .  Preventive care ( 47 cases ) , represented an average cost per case of US$ 880 ( 1 US$ 1993=BEF 30.65 ) . Curative care ( 120 cases ) , including  diagnostic tests , wound dressings , antibiotic therapy , revascularization and off loading techniques  result ed in a mean cost of US$ 5227 per ulcer . Care for the 16 most severe wounds and amputations involved hospitalization and surgery at a mean cost per ulcer of US$ 31716 . The most important cost contributers were hospitalizations ( 72 % ) , drugs ( 11 % ) and diagnostic examinations ( 4 % ) . Preventive treatment for diabetic foot problems can represent a significant saving for the social insurance system as well as for the patients Abstract Objective : To calculate costs for the management of deep foot infections and to identify the most important factors related to treatment costs . Design : Costs for  in-hospital care , surgery , investigations , antibacterials  , visits to the foot-care team , orthopaedic appliances and topical treatment were calculated retrospectively from diagnosis until healing or death . Multiple regression analysis was used to identify factors that independently affect costs . Setting : A multidisciplinary foot-care team . Patients : 220 prospect ively followed patients with diabetes mellitus and deep foot infections who were referred to the team from 1986 to 1995 . Main Outcome Measures and Results : Total cost for healing without amputation was Swedish kronor (SEK)136 600 per patient , while the corresponding cost for healing with minor amputation was SEK260 000 and with major amputation was SEK234 500 . All costs were quoted in SEK at 1997 price levels ( £ 1 sterling and $ US1 equalled approximately SEK12.50 and SEK7.64 , respectively ) . The cost of antibacterials  was 4%of total costs . The cost of topical treatment was 51 % of total costs and related to wound healing time . Number of weeks between diagnosis of deep foot infection and healing , and number of surgical procedures were variables that explained 95 % of costs in the multiple regression analysis . It was not possible to find any parameters present at diagnosis that could contribute to an explanation of total treatment costs . Conclusions : Topical treatment accounted for the largest proportion of total costs and the most important cost driving factors were wound healing duration and repeated surgery . Costs of antibacterials  should not be used as an argument in the choice between early amputation and conservative treatment Diabetic foot ulcers ( DFUs ) are a leading cause of morbidity and hospitalisation among patients with diabetes . We analysed cl aims data for Medicare part B diabetic foot ulcer patients treated with Negative Pressure Wound Therapy at home ( N = 1135 ) and diabetic foot ulcer patients from a published meta- analysis of r and omised controlled wet-to-moist therapy .  The expected costs of care for the two treatments were also compared . A significantly greater proportion of wounds treated with NPWT achieved a successful treatment endpoint compared with wet-to-moist therapy at both 1 
    Output:
    
Despite heterogeneity of foot complications and geographic variations , the search methodology revealed substantial costs and further healthcare burden for people with diabetes .
Amputations due to suboptimally treated foot infections contribute to the already high rates of hospitalizations and readmissions .
Moreover , the findings suggest that the cost of amputation in the US is generally higher compared to the cost in European countries .